HYGIENE  OF  THE 

STARR. 


GENERAL  MANAGEMENT  OF 

FEEDING*    DIET -LISTS' 

CLOTHING'       SLEEP' 
EMERGENCIES- 
MASSAGE* 


ILLUSTRATED* 


HYGIENE  OF  THE  NURSERY 


STARR 


BY  THE  SAME  AUTHOR 


THE     DIGESTIVE    ORGANS    IN    CHILDHOOD.    The 

Diseases  of  the  Digestive  Organs  in  Infancy  and  Childhood. 
With  Chapters  on  the  Investigation  of  Disease,  the  Manage- 
ment of  Children,  Massage,  etc.  Third  Revised  Edition. 
With  Lithograph  Plates  and  Wood  Engravings. 

Price,  Cloth,  $3.00  net. 

P.  BLAKISTON'S  SON  &  Co.,  Publishers 
1012  Walnut  Street,  Philadelphia 


HYGIENE 


OF 


THE  NURSERY 


INCLUDING  THE  GENERAL  REGIMEN  AND  FEED- 
ING OF  INFANTS  AND  CHILDREN;   MASSAGE, 
AND  THE  DOMESTIC  MANAGEMENT  OF 
THE  ORDINARY  EMERGENCIES 
OF  EARLY  LIFE 


BY 
LOUIS  STARR,  M.  D.,  L.L.  D. 


EIGHTH   EDITION 
WITH  TWENTY-SIX  ILLUSTRATIONS 


PHILADELPHIA 
P.   BLAKISTON'S   SON   &   CO. 

1012  WALNUT  STREET 
1913 

Twenty-second  Thousand. 


COPYRIGHT,  1913,  BY  Louis  STARR,  M.  D. 


THE • MAPLE*  PRESS*  YORK.  PA 


TO 
MY   LITTLE    PATIENTS 

SOME   OF   WHOM 

IN   THE   RAPID    PASSING   OF   TIME,   MAY  SOON  ASSUME 
PARENTAL   DUTIES 

THIS  VOLUME 
IS  AFFECTIONATELY  DEDICATED 


PREFACE  TO  THE  EIGHTH  EDITION. 


In  the  preparation  of  this  edition  of  HYGIENE 
OF  THE  NURSERY  the  subject  matter  has  been  care- 
fully revised,  and  amended  wherever  necessary  to 
keep  abreast  with  the  advances  and  improvements 
constantly  being  made  in  the  methods  of  managing 
infants  and  children.  Special  attention  has  been 
given  to  the  chapter  on  "Food,"  and  numerous 
additions  have  been  made  to  the  "Dietary." 
These  changes  and  additions  the  writer  believes  will 
materially  enhance  the  working  value  of  the  book, 
and  perhaps  increase  its  claim  to  the  favor  which 
has  been  so  flatteringly  accorded  to  it  in  the  past. 

LOUIS  STARR. 
1818  SOUTH  RITTENHOUSE  SQUARE, 
PHILADELPHIA. 


Vll 


PREFACE  TO  THE  FIRST  EDITION. 


Having  a  firm  belief  in  the  proverb  that  "an 
ounce  of  prevention  is  worth  a  pound  of  cure,"  the 
author  has  endeavored,  in  the  succeeding  pages,  to 
point  out  a  series  of  hygienic  rules  which,  if  applied 
to  the  nursling,  can  hardly  fail  to  maintain  good 
health,  give  vigor  to  the  frame  and  so  lessen  suscep- 
tibility to  disease. 

He  feels,  too,  that  intelligent  parents  are  ever 
ready  to  be  instructed  and  willing  to  cooperate  in 
the  great  work  of  preventing  disease — the  highest 
aim  of  scientific  medicine. 

While  every  woman  of  ordinary  brain-power  can 
do  much  to  keep  her  baby  well,  she  should  recog- 
nize that  years  of  training  and  experience  are 
necessary  to  acquire  the  ability  to  put  the  full  value 
upon  symptoms,  and  to  handle  the  tools  of  medicine. 
Therefore,  little  or  no  reference  has  been  made  to 
drugs  or  methods  of  medical  treatment. 

The  first  chapter  is  written  with  the  object  of 
hinting  to  the  mother  when,  by  deviations  from  the 
features  of  health,  she  may  expect  the  onset  of  dis- 
ease and  call  in  professional  counsel.  The  last  is 

ix 


X  PREFACE    TO    THE    FIRST   EDITION 

offered,  not  as  a  complete  guide  to  the  practice  of 
physic,  but  simply  for  the  sake  of  giving  informa- 
tion upon  questions  that  often  arise  in  the  nursery. 

The  child's  doctor,  in  our  day,  regulates  his 
patient's  diet,  clothing,  bathing  and  exercise,  and 
looks  into  the  hygiene  of  the  nursery  before  he 
orders  medicines,  and  if  the  mother  has  sound  ideas 
upon  these  subjects  she  is  no  mean  assistant. 

The  author's  thanks  are  due  to  Dr.  W.  M. 
POWELL  for  efficient  aid  in  the  preparation  of  the 
manuscript  and  index,  and  to  Dr.  ALLEN  J.  SMITH 
for  the  illustrations. 

LOUIS  STARR. 
PHILADELPHIA. 


CONTENTS. 


CHAPTER  I. 

PAGE. 
THE  FEATURES  OF  HEALTH i 

CHAPTER  II. 
THE  NURSERY 51 

CHAPTER  III. 
THE  NURSE-MAID 69 

CHAPTER  IV. 
CLOTHING 75 

CHAPTER  V. 
EXERCISE  AND  AMUSEMENTS 98 

CHAPTER  VI. 
SLEEP in 

CHAPTER  VII. 
BATHING     115 

CHAPTER  VIII. 
FOOD .  146 

CHAPTER  IX. 
DIETARY     230 

CHAPTER  X. 
MASSAGE 267 

CHAPTER  XI. 
EMERGENCIES 278 

INDEX     323 

xi 


HYGIENE  OF  THE  NURSERY. 


CHAPTER  I. 

THE  FEATURES  OF  HEALTH. 

Every  ill  child  presents  certain  well-defined  alter- 
ations in  the  manner  of  performance  of  the  various 
functions  of  the  body.  Thus,  the  pulse  and  respi- 
ration may  be  altered  in  character  and  frequency; 
the  surface  temperature  may  be  elevated;  the  color 
and  condition  of  the  skin  may  be  changed;  the 
appetite  may  be  diminished;  weight  may  be  lost, 
and  so  on.  These  alterations  from  the  normal  state 
are  termed  symptoms. 

Healthy  children,  on  the  other  hand,  as  uniformly 
show  evidences  of  their  well-being,  which,  for  want 
of  a  better  name,  may  be  called  the  features  of 
health.  Of  these  every  mother  should  have  a  full 
knowledge,  so  that  by  appreciating  variations  she 
may  anticipate  the  complete  development  of  disease, 
and  early  summon  skilled  aid,  at  the  time  when  it 
is  of  most  service. 

Early  life  must  be  divided  into  two  periods, 
namely,  infancy  and  childhood.  Infancy  is  the 


.'-*      HYGIENE   QF.  THE   NURSERY 

time  elapsing  between  birth  and  the  complete 
eruption  of  the  milk  teeth,  an  event  that  transpires 
about  the  end  of  the  second  year  of  life.  Child- 
hood extends  from  this  age  to  the  development  of 
puberty,  or  to  the  age  of  thirteen  or  fifteen  years. 
It  is  important  to  remember  these  two  divisions,  as 
frequent  reference  will  be  made  to  them  in  the 
subsequent  pages. 

With  this  brief  preparation,  the  study  of  the 
features  of  health  may  be  entered  upon. 

i.  The  Face. — The  face  of  a  healthy,  sleeping 
child  wears  an  expression  of  absolute  repose.  The 
eyelids  are  completely  closed,  the  lips  very  slightly 
parted,  and,  though  a  faint  sound  of  rhythmical 
breathing  may  be  heard,  there  is  no  visible  move- 
ment of  the  nostrils.  When  awake  and  undisturbed, 
the  healthy  infant's  face  has  a  look  of  wondering 
observation.  As  age  advances,  intelligence  gradu- 
ally supplants  the  wondering  gaze,  and  all  are 
familiar  with  the  bright,  round,  happy  face  of  per- 
fect childhood,  so  indicative  of  careless  content- 
ment, and  so  mobile  in  response  to  emotions. 

Examples  of  Variations  in  Disease. — Incomplete 
closure  of  the  eyelids,  rendering  the  whites  of  the 
eyes  visible  during  sleep,  is  a  symptom  in  all  acute 
and  chronic  diseases  of  a  severe  type;  it  is  also  to 
be  observed  when  rest  is  rendered  unsound  by 
pain,  wherever  seated.  Twitching  of  the  eyelids, 


THE    FEATURES    OF  HEALTH  3 

associated  with  oscillation  of  the  eyeballs  or 
squinting,  heralds  the  visit  of  convulsions.  Widen- 
ing of  the  orifices  of  the  nose,  with  movements  of  the 
nostrils  to  and  fro,  points  to  embarrassed  breathing 
from  diseases  of  the  lungs  or  their  pleural  invest- 
ment. Contraction  of  the  brows  indicates  pain  in 
the  head;  sharpness  of  the  nostrils,  pain  in  the 
chest;  and  a  drawn  upper  lip,  pain  in  the  abdomen. 
To  make  a  general  rule,  it  may  be  stated  that  the 
upper  third  of  the  face  is  altered  in  expression  in 
affections  of  the  brain;  the  middle  third  in  diseases 
of  the  chest,  and  the  lower  third  in  diseases  of  the 
organs  contained  in  the  abdominal  cavity. 

2.  The  Skin  and  General  Appearance. — In  the 
new-born  infant  the  color  of  the  skin  varies  from 
a  deep  to  a  light  shade  of  red.  After  the  first  week 
this  redness  fades  away,  leaving  the  surface  yellow- 
ish-white. At  times  this  yellow  color  is  so  marked 
that  it  might  be  mistaken  for  jaundice  were  it  not 
that  the  whites  of  the  eyes  remain  perfectly  pearly, 
which  is  never  the  case  in  the  disease  mentioned. 
After  the  second  week  all  discoloration  disappears 
and  the  skin  assumes  its  typical  appearance. 

With  certain  well-known  natural  variations  in 

^\ 

complexion  the  skin  of  a  healthy  child  is  beauti- 
fully white  and  transparent.  The  cheeks,  palms  of 
the  hands  and  soles  of  the  feet  have  a  delicate  pink 
color,  while  the  general  surface  is  rosy  in  a  warm 


4  HYGIENE   OF   THE   NURSERY 

atmosphere  and  marbled  with  faint  blue  spots  or 
lines  in  a  cold  one;  this  mottling  is  most  marked 
on  the  extremities.  As  age  advances  the  coloring 
becomes  more  pronounced,  and  until  the  comple- 
tion of  childhood  the  complexion  is  much  fresher 
than  in  adult  life. 

Other  characters  of  the  healthy  skin  are  a 
velvety  smoothness  and  softness,  a  scarcely  per- 
ceptible moisture,  and  a  great  degree  of 
elasticity. 

If  an  infant  be  stripped  the  large  size  of  the  head 
and  trunk,  and  the  relatively  short  arms  and  even 
shorter  legs,  will  strike  the  observer  at  once.  This 
disproportion,  especially  noticeable  in  the  head,  is 
an  actual  one.  For  if  in  a  child  of  one  year,  for 
example,  the  distance  from  the  lower  edge  of  the 
chin  to  the  top  of  the  head  be  measured,  it  will  be 
found  to  be  equal  to  one-fourth  of  the  entire  length 
of  the  body.  The  vertical  length  of  the  head,  too, 
falls  but  little  short  of  that  of  the  trunk,  and  the 
latter  in  turn  is  nearly  as  long  as  the  legs. 

Again,  the  abdomen  is  full  and  prominent,  making 
the  chest  look,  in  comparison,  rather  contracted  and 
narrow,  and  the  navel  is  less  deeply  sunken  than  in 
adults. 

These  features,  which  will  be  referred  to  more 
minutely  in  a  later  section,  are  most  marked  in 
young  infants,  and  undergo  gradual  alterations  as 


THE   FEATURES   OF  HEALTH  5 

growth  progresses  and  the  child  develops  into  the 
lithe,  active  youth  or  maiden. 

The  shape  of  the  head  varies  greatly  between 
the  round,  bullet  form  and  the  elongated  oval  one. 
When  it  has  been  subjected  to  much  pressure, 
instrumental  or  otherwise,  during  delivery,  it  is 
often  so  distorted  as  to  shock  the  expectant  mother. 
Little  fear  of  permanent  disfigurement  need  be 
entertained,  however,  as  in  time  the  deformed  head 
usually  assumes  a  natural  shape.  The  same  is  true 
of  less  noticeable  depressions,  prominences  and 
irregularities.  But  it  should  be  remembered  that 
restoration  to  symmetry  must  be  left  entirely  to 
nature,  as  any  attempt  to  press  or  mould  the  bones 
of  the  skull  into  shape  rarely  fails  to  injure  the  deli- 
cate brain  beneath. 

The  anterior  fontanelle,  or,  as  it  is  called  by 
nurses,  "the  opening  of  the  head,"  is  readily  seen 
and  felt  in  infants  under  a  year  old.  In  the  nor- 
mal state  it  is  level  with,  or  very  slightly  depressed 
below,  the  surrounding  bones  of  the  skull,  and 
may  be  observed  to  pulsate,  or  rise  and  fall, 
rhythmically.  It  is  soft  to  the  touch  and  yields 
readily  to  pressure. 

Examples  of  Variations  in  Disease. — Lividity  of 
the  eyelids  and  lips  is  a  sign  of  imperfect  oxida- 
tion of  the  blood,  and  points  to  disease  of  the 
heart  or  lungs.  A  decided  yellow  color  of  the 


6  HYGIENE   OF  THE  NURSERY 

skin  and  whites  of  the  eyes  is  seen  in  jaundice;  an 
earthy  tinge  of  the  face,  in  long-standing  disease  of 
the  bowels;  a  waxy  pallor  in  kidney  disease,  and 
paleness  in  any  acute  or  chronic  affection  attended 
by  exhaustion. 

Marked  squareness  of  the  head  with  projection 
of  the  forehead,  a  widely-open  fontanelle,  and  a 


FIG.  i. — DIAGRAM  SHOWING  SHAPE  OF  HEADS. 
a,  Normal  head;  b,  Hydrocephalic  head;  c,  Rickety  head. 


relatively  small  face  indicate  rickets.  A  very  large, 
globular  head  is  characteristic  of  hydrocephalus  or 
"water  on  the  brain;"  bulging  of  the  fontanelle  is 
also  a  symptom  of  this  disease.  In  this  connection 
it  must  be  observed,  however,  that  certain  children, 
in  every  respect  healthy,  are  born  with  relatively 


THE   FEATURES    OF  HEALTH  7 

large  globe-shaped  heads.  This  peculiarity  is 
especially  apt  to  be  observed  when  one  of  the 
parents — notably  the  father — has  the  same  charac- 
teristic. In  order  to  indicate  disease,  the  deformity 
must  be  marked  and  combined  with  a  widely  open, 
bulging  fontanelle,  or  with  indications  of  impaired 
brain  activity.  Depression  of  the  fontanelle  shows 
general  debility  and  the  need  of  food  or  stimulants. 

The  accompanying  diagram  (Fig.  i)  will  aid  in 
explaining  this  subject. 

Great  distention  of  the  abdomen  is  usually  due 
to  an  accumulation  of  gas  in  the  intestines,  and 
indicates  disease  of  this  portion  of  the  digestive 
tract;  marked  depression,  on  the  other  hand,  is 
encountered  in  serious  brain  affections,  in  cholera 
infantum,  inflammation  of  the  intestines  and  dys- 
entery. 

3.  Development. — To  be  robust  the  newly  born 
infant  must  have  a  certain  average  length  and 
weight.  The  length  varies  between  sixteen  and 
twenty-two  inches,  and  the  weight  between  six  and 
eight  pounds. 

From  the  first  day,  growth  or  increase  in  length 
and  weight  steadily  progresses  according  to  certain 
definitely  fixed  rules. 

Length  increases  most  rapidly  during  the  first 
week  of  life;  afterward  the  progress  is  almost  uni- 
form up  to  the  fifth  month,  and  then  it  becomes  less 


8 


HYGIENE   OF   THE   NURSERY 


rapid,  though  still  uniform,  until  the  end  of  the 
twelfth  month. 
These  facts  may  be  seen  in  the  following  table: 


Age. 

Length. 

Birth 

19.5  inches. 

i  month 

20.5  inches. 

2  months 

2  1  .    inches. 

3  months 

22  .    inches. 

4  months 

23  .    inches. 

5  months 

23  .  5  inches. 

6  months 

24  .    inches. 

7  months 

24.5  inches. 

8  months 

25.    inches. 

9  months 

25.5  inches. 

10  months 

26  .    inches. 

ii  months 

26.5  inches. 

12  months 

27.    inches. 

During  the  second  year  the  increase  is  from  three 
to  five  inches;  in  the  third  from  two  to  three  and 
a  half  inches;  in  the  fourth  from  two  to  three  inches, 
and  from  this  age  up  to  the  sixteenth  year  the 
average  annual  gain  is  from  one  and  two-thirds  to 
two  inches. 

In  the  first  three  days  of  life  there  is  always  a 
loss  of  weight,  but  by  the  seventh  day  the  baby 
should  have  regained  weight  and  be  as  heavy  as 


THE   FEATURES    OF  HEALTH  9 

at  birth.  The  period  of  most  rapid  gain  in  this 
respect  is  during  the  first  five  months  of  life.  The 
maximum  is  attained  during  the  second  month, 
when  the  increase  is  from  four  to  seven  ounces  each 
week.  Throughout  the  next  three  months  the 
increase  amounts  to  about  five  ounces  per  week, 
and  in  the  remaining  months  of  the  first  year,  from 
two  to  five  ounces. 

The  subjoined  table  shows  the  average  rate  of 
gain: 


Age. 

Weight. 

Birth 

7    pounds. 

i  month 

7f  pounds. 

2  months 

9^  pounds. 

3  months 

1  1    pounds. 

4  months 

12  £  pounds. 

5  months 

14    pounds. 

6  months 

15    pounds. 

7  months 

1  6    pounds. 

8  months 

17    pounds. 

9  months 

18    pounds. 

10  months 

19    pounds. 

n  months 

20    pounds. 

12  months 

2  1    pounds. 

Increase  in  weight  and  stature  are  so  closely  re- 
lated to  the  quality  and  quantity  of  food  supplied  to 


10 


HYGIENE   OF   THE   NURSERY 


27 

26* 
26 

25* 
25 


24 


23 


22 


21 


20| 


spunoj 


THE  FEATURES   OF  HEALTH 


II 


ja;jcn5  ptiB  spunoj  en 


12  HYGIENE   OF   THE   NURSERY 

the  infant,  and  to  the  processes  of  digestion, 
absorption  and  assimilation,  in  other  words,  are 
such  perfect  indices  of  proper  nutrition  or  the  re- 
verse, that  it  is  important  to  keep  a  record,  during 
the  first  year  at  least,  of  these  two  features  of  de- 
velopment. This  can  be  graphically  accomplished, 
and  so  more  readily  appreciated,  by  placing  the 
data  upon  a  chart,  such  as  shown  by  Fig.  2.  Here 
the  average  normal  weight-gain  and  increase  in 
length  are  indicated  respectively  by  the  blue  and 
red  lines.  The  figures  at  the  top  of  the  main  chart 
denote  the  age  by.  weeks,  the  heavy  vertical  lines 
mark  periods  of  four  weeks,  the  lighter,  periods 
of  one  week.  The  figures  on  the  left  are  numerals 
of  weight,  the  heavy  horizontal  lines  mark  pounds, 
the  lighter,  quarter-pounds.  The  intersection  of 
these  sets  of  lines  form  squares,  one  for  every  weight 
and  age.  In  making  the  record  mark  a  dot  in  the 
square  corresponding  to  the  weight  and  age.  At 
the  next  observation  make  a  second  dot  in  the 
proper  square,  and  so  on.  These  dots  are  con- 
nected by  a  line,  and  a  comparison  of  this  line  with 
the  test  blue  line  shows  at  once  whether  or  not  the 
special  infant's  weight-gain  is  normal.  Gain  in 
length  is  marked  in  the  same  way,  near  the  red 
line,  in  the  upper  division  of  the  chart;  the  figures, 
already  mentioned  as  indicating  the  age  in  weeks, 
applying  equally  to  this  part  of  the  record,  while 


THE   FEATURES    OF  HEALTH  13 

the  numbers  at  the  extreme  top  of  the  chart  indicate 
length  in  inches. 

From  the  first  to  the  tenth  year  there  should 
be  a  yearly  gain  of  at  least  four  or  five  pounds. 
After,  to  the  sixteenth  year,  of  about  eight  pounds 
in  the  same  period. 

Parents  frequently  overestimate  the  weight  of 
their  children  by  placing  them  upon  the  scales 
when  completely  dressed.  To  be  accurate,  the 
weight  of  the  clothing  must  be  subtracted.  This 
may  be  estimated  at  about  three  pounds  for  a  child 
of  three  to  five  years,  four  pounds  for  one  of  eight 
years,  and  eight  pounds  at  fifteen  years. 

Another  reliable  evidence  of  the  proper  progress 
of  development  is  the  increase  in  the  girth  of  the 
chest.  In  an  infant  weighing  seven  pounds  and 
measuring  nineteen  and  a  half  inches  at  birth,  the 
girth  should  be  a  little  over  thirteen  inches.  By 
the  fourth  month  it  should  be  fifteen  inches;  by 
the  sixth,  sixteen;  by  the  twelfth,  about  seven- 
teen; by  the  fifth  year,  twenty-one,  and  by  the 
sixteenth  year,  thirty  inches. 

As  already  mentioned,  the  proportions  of  the 
different  members  of  the  frame  in  infancy  differ 
materially  from  those  of  adolescence. 

Primarily  the  head  and  secondarily  the  body  are 
large  when  compared  with  the  arms  and  legs,  but 
in  the  progress  of  healthy  development  this  dis- 


14  HYGIENE   OF   THE   NURSERY 

proportion  is  gradually  lessened  until  the  perfect 
human  figure  is  attained.  This  developmental 
process,  however,  does  not  affect  all  parts  of  the 
body  equally,  as  may  be  seen  in  the  accompanying 
diagram.*  (Fig.  3.) 

The  description  is  so  well  put  in  the  journal  from 
which  this  figure  is  taken  that  I  cannot  do  better 
than  quote  it  word  for  word : 


FIG.  3. — DIAGRAM  SHOWING  RELATIVE  STATURE  FROM  i  TO  22 
YEARS  OF  AGE. 

"The  six  figures  represent  the  average  relative 
stature  of  males  of  the  ages  of  one,  five,  nine,  thir- 
teen, seventeen,  and  twenty-two  years.  It  will  be 
noticed  that  the  figures  all  stand  on  a  level  plain. 
The  tops  of  the  heads  are  connected  by  a  dotted 
line,  and  the  height  of  each  figure  is  divided  into 

*  "Babyhood,"  Vol.  II.  page3n.    Paper  by  Leroy  M.  Yale,  M.  D. 


THE    FEATURES    OF   HEALTH  15 

four  equal  parts,  the  points  of  division  being  con- 
nected with  the  corresponding  ones  in  each  figure. 
If  the  rate  of  growth  were  uniform  the  dotted  lines 
connecting  the  heads  would,  of  course,  be  straight 
if  a  child  for  every  year  were  included  in  the  rank. 
But  in  the  earlier  years  the  growth  is  much  more 
rapid  than  it  is  later,  and  hence  the  line  is  a  curve, 
rising  quite  suddenly  at  the  first,  and  becoming 
flatter  toward  the  end  of  growth.  It  is  to  be  under- 
stood that  these  are  all  averages,  including,  but  not 
showing,  the  extremes  of  slowness  and  rapidity 
of  growth  as  well  as  fitfulness  of  growth.  The 
diagram  also  shows  the  different  development  of 
different  parts  of  the  person.  The  head,  for  in- 
stance, in  the  child  of  one  year  is  nearly  one-fourth 
of  the  whole  height;  that  of  the  adult  is  about 
two-thirteenths,  or,  to  use  the  phrase  of  artists, 
the  little  child  is  not  much  more  than  four  heads 
high,  while  the  adult  of  twenty-two  is  about  six 
and  one-half  heads  high;  and  even  this  is  a  much 
larger  head  than  the  average  adult  has.  Notice 
that  the  third  dotted  line,  marking  one-half  of  the 
total  height,  crosses  the  navel  in  the  infant,  while 
in  the  adult  the  half  height  mark  is  but  little  above 
the  juncture  of  the  legs  and  the  body,  which  shows 
how  much  larger,  proportionately,  the  body  of  an 
infant  is  than  an  adult's.  If  this  same  line  be  fol- 
lowed it  will  be  noticed  that  it  keeps  well  up  in 


1 6  HYGIENE   OF   THE   NURSERY 

the  abdomen  until  after  the  age  of  nine.  Between 
that  age  and  puberty  the  growth  of  the  lower  ex- 
tremities is  usually  very  rapid,  and  the  well-known 
'shooting  up'  of  boys  and  girls  takes  place,  the 
whole  person  growing,  but  the  lower  part  in  par- 
ticular. Similar  changes  of  location  will  be  noticed 
by  following  the  quarter-lines,  but  the  changes  are 
not  so  abrupt." 

It  may  be  well  to  mention  here  that  children 
will  often  remain,  for  a  considerable  time,  almost 
stationary  in  height,  and  then  have  periods  of  very 
rapid  growth.  The  latter  is  often  to  be  observed 
in  the  ninth  or  tenth  year,  and  again  at  the  approach 
of  puberty.  Variations  in  weight-gain  are  also 
often  to  be  observed;  these  seem  to  hold  a  defi- 
nite relation  to  the  fluctuations  in  the  rapidity  of 
height-increase. 

Besides  these  points,  which  are  the  most  reliable 
evidences  of  the  proper  progress  of  development, 
there  are  certain  features  that  appeal  more  directly 
to  the  notice  of  parents,  and  on  this  account  deserve 
consideration.  The  age  at  which  a  child  sits  erect, 
at  which  it  creeps,  walks  or  talks,  are  instances  of 
the  class  of  features  referred  to. 

The  head  can  usually  be  held  erect  by  the  end 
of  the  third  month  and  the  body  maintained  in  the 
sitting  posture  a  month  later.  By  the  sixth  month 
the  infant  can  sit  up  with  ease,  accomplish  many 


THE   FEATURES    OF  HEALTH  17 

movements  with  the  arms,  hands  and  fingers,  and 
enjoy  playthings.  At  the  eighth  month  he  may 
be  able  to  creep;  by  the  ninth  or  tenth,  to  drag 
himself  upon  his  feet  with  the  assistance  of  his 
hands  and  arms  and  some  artificial  support;  by  the 
eleventh,  to  walk  with  assistance;  by  the  fourteenth, 
to  walk  alone,  and  ty  the  eighteenth,  to  run. 

At  eight  months  an  infant  will  imitate  sounds 
and  articulate  several  syllables;  at  ten,  can  often 
speak  one  or  two  words,  and  after  twelve  months 
is  able  to  join  several  words  together. 

The  anterior  fontanelle  should  be  completely 
closed  at  some  period  between  the  fifteenth  and 
twentieth  months. 

Tears  begin  to  be  secreted  during  the  third  or 
fourth  month,  and  saliva,  between  the  fifth  and 
sixth. 

After  birth  both  hair  and  eyes  often  change  color 
as  age  advances.  When  an  alteration  takes  place 
in  the  eyes — which  are  quite  commonly  blue  or 
blue-gray  in  the  new-born — it  begins  about  the 
sixth  or  eighth  week  and  may  be  to  either  a  lighter 
or  darker  hue.  Changes  in  the  hair  begin  later,  the 
tendency  always  being  to  darken,  and  the  most 
marked  alteration  occurring  between  the  seventh 
and  fourteenth  years. 

Examples  of  Variations  in  Disease. — If  on  being 
measured  and  weighed,  a  child  be  found  to  fall 


1 8  HYGIENE    OF    THE   NURSERY 

short  of  the  normal  standard  for  its  age,  and  if, 
at  the  same  time,  there  be  a  want  of  plumpness  of 
body,  roundness  of  limb,  and  firmness  of  flesh,  the 
existence  of  some  fault  in  diet  or  in  the  digestion 
and  absorption  of  food  must  be  inferred. 

A  delay  in  walking  may  be  due  to  general  feeble- 
ness or  to  paralysis  of  the  muscles  of  one  or  both 
legs,  and  a  limping  gait  with  pain  in  the  knee 
suggests  hip-joint  disease. 

Closure  of  the  fontanelle  is  retarded  by  the 
disease  called  rickets,  and  also  by  hydrocephalus 
and  constitutional  syphilis. 

It  is  well  to  be  cognizant  of  the  fact  that  girls 
develop  more  rapidly  than  boys,  and  that  the  second 
or  later  children  of  the  same  family,  by  imitating 
their  elders  in  the  nursery,  learn  to  talk  and  walk 
earlier  than  those  who  are  born  first. 

4.  Position  and  Gestures. — The  complete  re- 
pose depicted  on  the  countenance  of  a  sleeping 
child  when  free  from  illness  is  shown  also  by  the 
posture  of  the  body.  The  head  lies  easy  on  the 
pillow,  the  trunk  rests  on  the  side,  slightly  inclined 
backward,  the  limbs  assume  various  but  always 
most  graceful  attitudes,  and  no  movement  is 
observable  but  the  gentle  rise  and  fall  of  the 
abdomen  in  respiration.  In  the  waking  state,  the 
child,  after  early  infancy,  is  rarely  still.  The  move- 
ments of  the  arms,  at  first  awkward,  soon  become 


THE    FEATURES    OF  HEALTH  1 9 

full  of  purpose  as  he  reaches  to  handle  and  examine 
various  objects  about  him.  The  legs  are  idle 
longer,  although  these,  too,  soon  begin  to  move 
about  with  method,  feeling  the  ground  in  prepara- 
tion, as  it  were,  for  creeping  and  walking. 

Examples  of  Variations  in  Disease. — Restless 
sleep,  with  a  desire  to  be  rocked,  fondled  or  "walked" 
in  the  nurse's  arms,  are  common  symptoms  of  acute 
attacks  of  illness,  especially  when  attended  by  pain. 
Children  beyond  the  age  of  infancy  toss  about 
uneasily  in  bed  or  want  a  change  from  the  bed 
to  the  lap,  under  similar  circumstances.  Extreme 
and  long-continued  drowsiness  and  quietness,  on 
the  other  hand,  often  precede  the  onset  of  such 
specific  fevers  as  scarlatina  or  measles. 

Sleeping  with  the  head  thrown  back  and  the 
mouth  open  indicates  enlarged  tonsils  or  adenoid 
growths;  a  tendency  to  "sleep  high,"  or  with  the 
head  and  shoulders  elevated  by  the  pillow,  accom- 
panies disease  of  the  heart  and  lungs,  and  "sleeping 
cool,"  that  is,  resting  only  after  the  bedclothes  have 
been  kicked  off,  is  an  early  symptom  of  rickets. 

Frequent  carrying  of  the  hand  to  the  head,  ear, 
or  mouth  shows  headache,  earache,  or  pain  of 
a  coming  tooth.  Constant  rubbing  of  the  nose  is 
a  feature  of  irritation  of  the  bowels  or  stomach. 

Should  the  thumbs  be  drawn  into  the  palms  of 
the  hands,  and  the  fingers  tightly  clasped  over 


20  HYGIENE   OF   THE   NURSERY 

them,  or  if  the  toes  be  strongly  flexed  or  extended, 
a  convulsion  may  be  expected. 

5.  The  Voice. — -Crying  is  the  chief  if  not  the 
only  method  that  the  young  infant  possesses  of 
making  known  his  displeasure,  discomfort  or  suffer- 
ing and  affords  almost  the  sole  means  of  determin- 
ing the  characters  of  the  voice  at  this  early  age. 
Again,  even  long  after  the  powers  of  speech  have 
been  developed,  the  cry  continues  to  be  the  main 
channel  of  complaint. 

One  rarely  hears  a  healthy  child  cry,  unless  a 
harsh  word,  a  fall  or  a  blow  cause  a  passing  storm 
of  grief,  anger  or  pain.  Hence,  frequent,  peevish 
crying  points  to  some  disturbance  of  the  healthy 
balance. 

The  sound  of  the  voice,  whether  in  crying  or 
speaking,  should  have  a  clear  ring,  without  either 
muffling,  hoarseness  or  nasal  tone.  Weeping 
should  accompany  crying,  after  the  establishment 
of  tear  secretion.  Cough,  although  not  a  normal 
vocal  sound,  is  also  worthy  of  attention. 

Examples  of  Variations  in  Disease. — Incessant, 
unappeasable  crying  is  usually  due  to  earache  or 
hunger;  it  frequently,  too,  is  caused  by  the  constant 
pricking  of  a  badly-adjusted  safety-pin  or  other 
mechanical  irritant. 

If  crying  occur  during  an  attack  of  coughing  it 
is  an  indication  of  some  painful  affection  of  the 


THE    FEATURES    OF  HEALTH  21 

chest;  if  just  before  or  after  an  evacuation  of  the 
bowels,  of  intestinal  pain. 

When  the  cry  has  a  nasal  tone  it  should  suggest 
swelling  of  the  lining  membrane  of  the  nose,  or 
other  obstructing  condition.  Thickening  and  indis- 
tinctness occur  with  throat  affections.  A  loud, 
brazen  cry  is  a  precursor  of  spasmodic  croup,  and 
a  faint,  whispering  cry,  of  true  or  membranous 
croup.  Hoarseness  points  to  disease  of  the  lining 
membrane  of  the  larynx,  either  catarrhal  or  syphi- 
litic in  nature. 

Finally,  a  manifest  unwillingness  to  cry  can  be 
seen  in  pneumonia  and  pleurisy,  when  the  dis- 
ease is  severe  enough  to  interfere  materially  with 
breathing. 

Tear-secretion  having  been  established,  it  is  a 
bad  omen  if  the  secretion  be  arrested  during  the 
progress  of  an  illness,  but  an  equally  good  one  if 
there  be  no  suppression,  or  if  there  be  a  reestab- 
lishment  after  suppression. 

The  cough,  like  the  voice,  may  be  brazen  in 
spasmodic  croup,  hoarse  in  laryngeal  catarrh,  and 
suppressed  in  true  croup.  The  qualities  "  tight- 
ness" and  "looseness"  are  readily  appreciated  and 
give  a  good  idea  of  the  progress  of  lung  affections, 
especially  bronchitis,  the  former  being  an  evidence 
of  the  beginning,  the  latter  of  the  favorable  termina- 
tion of  an  attack. 


22  HYGIENE    OF    THE   NURSERY 

Cough  is  always  unproductive,  that  is,  unattended 
by  expectoration,  in  children  under  seven  years  of 
age. 

6.  Mode  of  Drinking  and  Swallowing. — By 
watching  an  infant  taking  the  breast  or  bottle, 
some  information  can  be  obtained  of  the  condition 
of  the  mouth  and  throat,  and  of  the  respiratory 
organs.  A  healthy  child  drinks  continuously  with- 
out stopping  to  breathe,  and  swallows  easily. 

Examples  of  Variations  in  Disease. — If  there  be 
any  soreness  of  the  mouth  the  nipple  will  be  held 
only  for  a  moment  and  then  dropped  with  a  cry  of 
pain.  When  the  throat  is  affected  in  infants,  swal- 
lowing is  performed  with  a  gulp,  an  expression 
of  pain  passes  over  the  face,  and  no  more  efforts 
are  made  than  required  to  satisfy  the  cravings 
of  hunger.  Older  children,  under  similar  circum- 
stances, drink  little  and  refuse  solid  food. 

An  infant  suffering  from  the  oppressed  breathing 
of  pneumonia  or  severe  bronchitis,  seizes  the  nipple 
with  avidity,  swallows  quickly  several  times  and 
then  pauses  for  breath.  In  older  children  the  act 
of  drinking,  which  should  be  continuous,  is  inter- 
rupted in  the  same  way. 

If  the  finger  be  put  into  the  mouth  of  a  healthy 
baby  it  will  be  vigorously  sucked  for  some  little 
time.  Diminution  of  this  act  of  suction  during  a 
severe  illness  is  a  sign  of  danger;  its  reestablish- 


THE    FEATURES    OF  HEALTH  23 

ment  a  good  omen.  In  conditions  of  stupor  it  is 
noticeably  absent. 

7.  Appetite. — Hunger  and  appetite  must  not  be 
regarded  as  synonymous  terms.  The  former  is  the 
craving  of  all  the  tissues  of  the  body  for  nutritive 
material,  or  food,  and  is  expressed  by  a  sinking  or 
craving  sensation  in  the  stomach.  The  latter,  on 
the  other  hand,  though  it  is  certainly  an  attendant 
of  hunger,  is  simply  a  sensation  of  the  desire  for 
something  with  a  food-taste,  having  its  seat  in  the 
mouth  and  surrounding  parts.  Appetite  having  its 
post,  as  it  were,  at  the  entrance  of  the  stomach, 
may  be  regarded  as  a  gate-keeper  to  supervise 
everything  presented  for  entrance  and  to  reject  all 
that  may  be  injurious  either  to  the  stomach  or  the 
general  economy. 

Like  its  analogue  the  gate-keper,  the  trust- 
worthiness of  the  appetite  may  be  destroyed  by 
overindulgence  and  bad 'habits.  Under  the  last 
head  come  the  constant  administration  of  too  much 
or  too  little  food,  the  use  of  overrich  food  and 
irregularity  in  meal  hours. 

A  healthy  appetite — that  is,  one  that  leads  a  child 
to  consume  with  enjoyment  the  food  set  before 
him — may  be  encouraged  by  muscular  and  mental 
exercise;  by  contentment;  by  regular  habits  as  to 
the  hours  of  eating;  by  the  use  of  plain  food  only, 
and  by  varying  the  food,  in  a  greater  or  less  degree, 


24  HYGIENE   OF   THE   NURSERY 

according  to  the  age.  If  the  quantity  of  food  con- 
sumed at  the  regular  meals  does  not  come  up  to 
the  parent's  standard  of  sufficiency,  it  does  nothing 
but  harm  to  resort  to  too  dainty  feeding  and  to  an 
encouragement  to  eat  between  meals. 

There  can  be  no  question  that  a  good  appetite  is 
a  useful  as  well  as  a  pleasant  faculty  for  a  child  to 
possess,  for  there  is  no  doubt  that  food  eaten  with 
relish  is  much  better  digested  and  therefore  more 
serviceable  in  nutrition  than  that  which  is  simply 
crowded  into  the  stomach. 

Examples  of  Variations  in  Disease. — Loss  of  appe- 
tite is  encountered  in  febrile  attacks  and  in  acute 
disorders  of  the  stomach.  Inordinate  appetite,  on 
the  contrary,  is  usually  met  with  when  too  strong 
food  has  been  administered.  Here  the  increased 
hunger  is  due  to  the  fact  that  the  food  administered, 
while  it  may  be  very  rich  in  nutritive  properties,  is 
ill-adapted  to  the  delicate  digestive  power  of  early 
life,  and  thus,  by  not  being  properly  prepared  for 
absorption,  places  the  child  in  the  anomalous 
position  of  starving  in  the  midst  of  plenty.  In  more 
advanced  children  gluttony  may  depend  upon  gas- 
tric irritation,  a  condition  which  often  leads  older 
and  presumably  wiser  heads  to  over-indulgence  at 
table.  . 

8.  Eructation. — Eructation  or  regurgitation  is 
readily  produced  and  of  frequent  occurrence  in 


THE    FEATURES    OF  HEALTH  25 

infancy,  on  account  of  the  vertical  position  and 
more  cylindrical  outline  of  the  stomach  at  this 
period  of  life. 

Babies  suckled  at  a  freely- secreting  breast  often 
eructate,  though  they  may  be  in  the  best  possible 
health.  In  these  cases,  the  supply  of  food  being 
large,  the  infant,  as  it  lies  at  the  breast,  is  apt  to 
draw  more  than  it  needs  and  more  than  it  can 
digest,  and  the  stomach,  through  a  wise  provision 
of  nature,  rids  itself  of  the  superabundance  by  the 
simple  act  of  regurgitation.  In  this  process,  which 
in  reality  is  an  evidence  of  health,  there  is  no  vio- 
lent muscular  effort,  as  in  retching  or  vomiting,  nor 
any  evidence  of  nausea,  and  the  material  ejected  is 
the  breast  milk  alone,  either  entirely  unaltered  or 
slightly  curdled. 

In  older  children,  expulsion  of  the  contents  of 
the  stomach,  or  vomiting,  may  also  occur  after  the 
stomach  has  been  overladen.  If  the  act  be  followed 
by  relief  from  a  feeling  of  general  distress,  head- 
ache and  pain  in  the  upper  abdomen,  it  is  not  to  be 
regarded  as  a  symptom  of  disease. 

Examples  of  Variations  in  Disease. — Vomiting, 
with  its  violent  muscular  effort  and  the  attendance 
of  the  train  of  symptoms  embraced  under  the  term 
nausea — namely,  paleness,  languor,  faintness  and 
an  increased  secretion  of  saliva — occurs  in  many 
different  conditions.  It  may  indicate  disease  of  the 


26  HYGIENE    OF    THE   NURSERY 

stomach,  of  the  intestines,  of  the  lungs  or  their 
pleural  investment,  and  of  the  brain;  or  it  may  be 
an  initial  symptom  of  one  of  the  eruptive  fevers, 
scarlet  fever  or  measles,  for  example,  which  con- 
dition, when  existent,  can  only  be  determined  by 
closely  observing  the  special  case. 

The  character  of  the  material  ejected  from  the 
stomach  is  more  definite.  Thus,  the  expulsion  of 
mucus  is  a  symptom  of  gastric  catarrh.  The 
regurgitation  of  mouthfuls  of  curdled  milk,  partly 
digested  food  and  liquid,  so  sour  that  it  causes  a 
grimace  to  pass  over  the  face,  is  an  indication  of 
dyspepsia  with  fermentation  and  the  formation  of 
an  irritant  acid.  The  appearance  of  lumbricoid 
worms  in  the  vomit,  a  not  very  infrequent  occur- 
rence, shows,  without  dispute,  the  existence  of  these 
parasites  in  the  digestive  canal. 

9.  The  Faecal  Evacuations. — The  daily  num- 
ber of  evacuations  of  the  bowels  natural  for  a  child 
varies  greatly  with  its  age.  For  the  first  six  weeks 
there  should  be  three  or  four  movements  every 
twenty-four  hours.  After  this  time,  up  to  the  end 
of  the  second  year,  two  movements  a  day  is  the 
normal  average.  Subsequently,  the  frequency  is 
the  same  as  in  adults — once  per  diem — though  two 
or  three  movements  in  the  same  interval  may  occur, 
especially  after  overfeeding  or  after  eating  food 
difficult  of  digestion,  and  must  be  looked  upon  as 


THE    FEATURES    OF  HEALTH  2J 

conservative  rather  than  as  the  evidence  of  ill 
health. 

During  the  first  period  the  passages  have  the 
consistence  of  thick  soup,  are  yellowish-white  or 
orange-yellow  in  color,  with  sometimes  a  tinge  of 
green;  have  a  faint  faecal,  slightly  sour  odor,  and 
are  acid  in  reaction.  In  the  second,  they  are 
mushy  or  imperfectly  formed,  of  uniform  consistence 
throughout,  brownish-yellow  in  color,  and  have  a 
more  faecal  odor.  The  last  two  characters  become 
more  marked  as  additions  are  made  to  the  diet. 
After  the  completion  of  the  first  dentition  the 
motions  have  the  same  appearance  as  in  adult  life; 
they  are  formed,  are  brownish  in  color,  and  have  a 
decidedly  faecal  odor. 

Examples  of  Variations  in  Disease. — Many  altera- 
tions occur  in  disease.  The  frequency  of  the 
movements  may  be  increased,  constituting  diar- 
rhoea, or  lessened,  constituting  constipation.  In 
the  former  condition  the  consistency  is  diminished, 
in  the  latter,  increased.  Instead  of  being  uniform 
throughout,  the  movement  may  be  mixed,  partly 
liquid,  partly  solid,  indicating  imperfect  digestion, 
and  curds  of  milk  or  pieces  of  undigested  solid  food 
may  be  mingled  with  the  mass.  Flaky,  yellowish 
or  yellowish-green  evacuations  containing  whitish, 
cheesy  lumps,  are  also  met  with  in  cases  of  indiges- 
tion. Scanty,  lumpy  evacuations,  dark  brown  or 


28  HYGIENE    OF   THE   NURSERY 

even  black  in  color,  and  mixed  with  mucus,  are 
characteristic  of  intestinal  catarrh.  Doughy,  gray- 
ish, or  clay-colored  motions  show  an  inactive  liver. 
An  intermixture  of  blood,  altered  blood  clots,  and 
shreds  of  mucous  membrane,  indicate  ulceration  of 
the  intestinal  lining,  such  as  occurs  in  intestinal 
inflammation,  typhoid  fever,  dysentery  and  tuber- 
culous disease.  Watery,  almost  odorless  passages 
occur  in  the  later  stages  of  summer  complaint; 
most  offensive,  carrion-like  motions,  in  both  ca- 
tarrhal  and  tuberculous  ulceration  of  the  intestines, 
and  sour-smelling  evacuations  in  the  diarrhoea  of 
sucklings.  The  discovery  of  worms  in  the  move- 
ments is  the  only  certain  evidence  of  the  existence 
of  intestinal  parasites. 

This  mere  outline  of  the  changes  that  may  take 
place  will  serve  to  show  how  much  may  be  learned 
from  the  evacuations,  and  the  importance  of  pre- 
serving them  for  the  physician's  inspection. 

10.  The  Urine. — It  is  impossible  to  make  a 
definite  statement  as  to  the  number  of  times  the 
urine  is  voided  by  a  healthy  infant  in  each  twenty- 
four  hours.  In  any  given  case  the  frequency  will 
differ  very  much  from  day  to  day,  depending  upon 
the  temperature  of  the  surrounding  air  and  the 
amount  of  moisture  that  it  contains.  Sometimes 
it  will  be  necessary  to  change  the  napkin  every 
hour  during  the  day  and  three  or  four  times  at 


THE    FEATURES    OF  HEALTH  2 9 

night.  Again,  it  may  remain  dry  for  six,  eight,  or 
even  ten  hours.  Neither  condition  indicates  dis- 
ease. If,  however,  the  urine  is  not  passed  for  twelve 
hours,  a  careful  examination  should  be  made. 

Between  these  two  extremes  there  is  a  wide  range 
of  variation. 

As  the  child  grows  older  the  frequency  dimin- 
ishes, and  at  the  age  of  three  years  the  number  of 
voidings  will  be  reduced  to  six  or  eight  during  the 
waking  hours,  and  perhaps  one  at  night.  When 
the  desire  does  arise  during  sleep,  the  child,  if  in  a 
normal  state,  wakes  up  and  demands  the  chamber, 
and  never  passes  urine  unconsciously.  Wetting 
the  bed,  therefore,  or  the  involuntary  passage  of 
the  urine  during  sleep,  is  indicative  of  an  abnormal 
condition  and  requires  investigation.  The  quantity 
of  urine  voided  at  different  ages  may  be  stated  as 
follows,  the  figures  being  approximate  only: 

From  birth  to  2d  year 8-12  fluid  ounces. 

From  2d  to  5th  year 15-25  fluid  ounces. 

From  5th  to  roth  year 25~35  fluid  ounces. 

From  loth  to  i5th  year 35~4O  fluid  ounces. 

From  a  few  observations,  I  am  led  to  believe  that 
the  quantity  of  urine  voided  by  healthy  children 
from  the  fourth  to  the  seventh  years  is  often  not  as 
large  as  supposed,  eighteen  to  twenty  ounces  being 
the  average  in  several  cases  in  which  I  have  made 
measurements. 


30  HYGIENE    OF    THE   NURSERY 

The  urine  of  an  infant,  while  it  wets,  should  not 
stain  the  napkin. 

Examples  of  Variations  in  Disease. — In  certain 
cases  of  bad  digestion  the  urine  becomes  very  con- 
centrated and  high-colored,  and  gives  a  light  yellow 
tinge  to  the  napkin.  When  the  stain  is  decidedly 
yellow,  jaundice  is  indicated,  and  other  symptoms 
of  this  condition  should  be  looked  for. 

In  older  children  a  high-colored  urine,  and  one 
which  deposits  a  whitish  or  pinkish  sediment  on 
standing,  is  symptomatic  of  acute  digestive  dis- 
order, either  catarrhal  in  its  nature,  or  secondary 
to  some  acute  febrile  affection.  A  smoky,  blackish 
hue,  looking  as  if  there  had  been  an  admixture  of 
soot,  is  characteristic  of  the  acute  kidney  disease 
that  often  follows  in  the  wake  of  scarlet  fever.  In 
this  state,  too,  there  is  a  great  diminution  in  the 
amount  passed.  The  deposition  of  a  "brick-dust" 
sediment  in  the  napkin,  or  upon  the  bottom  of  the 
chamber  after  the  urine  has  been  standing  for  a 
time,  indicates  an  excessive  formation  of  uric 
acid. 

Painful  urination  points  to  inflammation  of  the 
bladder  or  urethra,  a  narrow  orifice,  a  highly  acid 
condition  of  the  excretion,  or  stone  in  the  bladder. 

ii.  The  Respiration. — In  adults  there  are  two 
well-marked  types  of  respiration,  viz.,  the  abdominal 
and  the  superior  costal.  The  abdominal — met  with 


THE    FEATURES    OF  HEALTH  31 

in  perfection  in  adult  males — is  the  type  in  which 
the  movements  of  inspiration  and  expiration  are 
performed  by  the  muscles  of  the  abdomen  and 
lower  third  of  the  chest.  In  superior  costal  respi- 
ration, on  the  other  hand,  the  movements  are  most 
marked  in  the  upper  third  of  the  chest.  This  form 
is  best  developed  injiealthy  adult  females. 

In  children  the  respiration  is  chiefly  abdominal 
in  type,  irrespective  of  sex,  and  it  is  not  until  just 
before  the  age  of  puberty  that  the  movements  in 
the  female  change,  becoming  superior  costal.  Con- 
sequently, in  estimating  the  number  of  movements 
per  minute  it  is  best  to  place  the  fingers  lightly  on 
the  upper  abdomen.  The  count  should  always  be 
made  by  the  watch,  the  most  convenient  time  for 
the  observation  being  while  the  child  sleeps. 

Soon  after  birth  the  number  of  movements  per 
minute  is  44,  between  the  ages  of  two  months  and 
two  years,  35,  and  between  two  and  twelve  years, 
23.  During  sleep  the  frequency  is  reduced  about 
twenty  per  cent. 

Children  under  two  years,  while  awake,  breathe 
unevenly  and  irregularly;  there  are  frequent  pauses 
followed  by  hurry  and  precipitancy,  and  some  of 
the  movements  are  shallow,  others  deep.  In  sleep 
there  is  greater  regularity.  After  the  second  year 
the  movements  become  steady  and  even,  like  those 
of  adults.  All  children,  however,  but  particularly 


32  HYGIENE    OF   THE   NURSERY 

the  very  young,  are  subject  to  a  great  increase  in 
the  rapidity  of  respiration  under  the  excitement  of 
muscular  movement  and  mental  emotion. 

Perfectly  healthy  children  breathe  through  the 
nose,  and  so  softly  that  it  is  necessary  to  place  the 
ear  close  to  the  face  to  hear  the  breezy  sound  of 
the  ingoing  and  outgoing  air. 

Examples  of  Variations  in  Disease. — Accelerated 
breathing  occurs  during  the  course  of  diseases  at- 
tended by  severe  fever.  Acute  affections  of  the 
lungs  are  especially  characterized  by  this  alteration, 
and  the  more  the  breathing  area  is  lessened  the 
greater  is  the  increase.  Thus,  in  pneumonia,  60, 
80  or  loo  movements  a  minute  are  not  at  all  un- 
usual. To  speak  broadly,  rapid  breathing  may  be 
caused  by  an  elevation  in  the  body  temperature, 
by  an  interference  with  the  blood  aeration,  and  by 
thoracic  or  abdominal  pain. 

Diminished  frequency — the  movements  being 
reduced  to  16,  12,  or  even  8  in  the  minute — is  en- 
countered in  certain  brain  affections — namely,  in 
chronic  hydrocephalus,  and  the  later  stages  of 
tuberculous  meningitis.  In  such  cases  the  rhythm 
may  be  greatly  altered — a  tidal  form  being  assumed, 
in  which  the  breathing  ebbs  and  flows,  beginning 
with  an  act  which  is  scarcely  perceptible  or  audible, 
gradually  growing  deeper  until  a  full,  noisy  respi- 
ration is  made,  and  then  slowly  subsiding  into  a 


THE   FEATURES    OF  HEALTH  33 

period  of  absolute  quiet,  variable  in  its  duration. 
This  is  termed  Cheyne-Stokes  respiration. 

A  dry,  hissing  sound,  or  a  moist  sound  of  snuf- 
fling, indicates  partial  obstruction  of  the  nasal 
passages;  oral  respiration  shows  their  complete 
occlusion. 

Yawning,  one  of  the  modifications  of  the  re- 
spiratory act,  if  it  recur  frequently,  denotes  great 
failure  of  the  vital  powers  and  is  an  unfavorable 
prognostic  element. 

12.  The  Pulse. — To  obtain  any  reliable  data 
from  the  pulse  it  must  be  felt  during  perfect  quiet. 
During  sleep  is  the  best  time,  but  if  the  child  can- 
not be  caught  in  this  condition,  advantage  may  be 
taken  of  its  placidity  while  feeding  or  amused  by  a 
toy.  With  very  young  infants  it  is  sometimes 
impossible  to  feel  the  beat  of  the  artery  at  the  wrist, 
and  it  is  necessary  to  ascertain  the  frequency  of  the 
pulse  by  listening  to  the  heart.  After  the  second 
month  feeling  the  pulse  at  the  wrist  in  the  ordinary 
way  is  not  difficult. 

The  child's  pulse  differs  from  the  adult's  in 
being  much  more  frequent,  more  irregular,  and 
more  irritable. 

The  frequency,  or  the  number  of  beats  per 
minute,  varies  with  the  age.  The  following  is  the 
average  rate : 


34  HYGIENE    OF   THE   NURSERY 

From  birth  to  2d  month 160  to  130 

From  2d  to  6th  month 130  to  120 

From  6th  to  i2th  month 120  to  no 

From  ist  to  3d  year no  to  100 

From  3d  to  5th  year 100  to    90 

From  5th  to  loth  year 90  to    80 

From  loth  to  I2th  year 80  to    70 

These  figures  represent  the  pulse  in  a  waking, 
but  passive  state.  During  sleep  the  frequency  is 
less.  Thus,  between  the  second  and  ninth  years 
there  are  about  sixteen  beats  less  per  minute  while 
asleep  than  when  awake;  between  the  ninth  and 
twelfth  years,  eight  less;  and  between  the  twelfth 
and  fifteenth  years,  only  two  less.  Below  the  age 
of  two  years  the  disparity  is  even  greater. 

The  irregularity  of  the  pulse  in  childhood  is 
confined  to  an  alteration  of  the  rhythm,  in  other 
words,  of  the  intervals  at  which  the  beats  succeed 
each  other  and  the  relative  strength  and  volume  of 
each  beat.  It  is  most  marked  in  infants  and  is 
greatest  during  sleep,  when  the  pulse  is  lowest. 

The  feature  of  irritability,  that  is,  the  facility 
with  which  the  frequency  is  increased  by  muscular 
activity  and  mental  excitement,  is  greater  in  pro- 
portion to  the  youth  of  the  child.  A  rise  of  20,  30, 
or  even  40  beats  a  minute  is  not  uncommon  in 
early  infancy,  under  the  excitement  of  the  slightest 
effort  or  disturbance. 

Examples  of  Variations  in  Disease. — On  account 


THE    FEATURES    OF  HEALTH  35 

of  the  wide  variations  in  health,  little  meaning 
need  be  attached  to  alterations  of  the  rhythm  and 
frequency  while  unassociated  with  other  abnormal 
features.  When  so  associated  they  become  impor- 
tant in  determining  the  existence  of  disease. 

Increased  frequency  is  a  constant  attendant  of  the 
febrile  state.  The  extent  of  the  increase  corre- 
sponds with  the  degree  of  elevation  of  temperature, 
though  the  pulse  curve  always  runs  higher  than  the 
temperature  curve.  As  a  rule,  the  more  frequent 
the  pulse  the  higher  the  fever.  In  estimating  the 
risk  of  the  increase,  however,  the  law  of  the  fever 
in  question  must  be  taken  into  consideration.  For 
example,  in  scarlet  fever  a  pulse  of  160  is  usual 
and  not  indicative  of  special  gravity.  In  measles, 
the  same  degree  of  acceleration  would  be  abnormal 
and  show  great  danger. 

Jaundice  and  inflammation  of  the  kidneys  are 
accompanied  by  a  diminution  of  the  pulse  rate. 

Irregularity  is  met  with  in  diseases  of  the  brain 
and  heart,  and  sometimes  in  nervous  and  blood- 
impoverished  children. 

13.  The  Temperature. —By  placing  the  hand, 
upon  the  surface  of  the  body  we  can  readily  detect 
marked  variations  in  the  temperature;  thus  the 
nose  and  extremities  feel  cold  in  diseases  associ- 
ated with  depression  of  the  vital  forces,  and  the 
palms  of  the  hands  and  back  of  the  head  feel  hot 


HYGIENE   OF   THE   NURSERY 


in  those  attended  by  fever.     But  the  only  possible 
means  of  detecting  slight  variations  or  of  obtain- 


98.5°  normal  mark. 

Index,  read  from  top, 
stands  now  at  98.5°. 


FIG.  4. — CLINICAL  THERMOMETER. 


ing  reliable  information  concerning  normal  or  ab- 
normal body-heat  is  by   the   employment  of   an 


THE    FEATURES    OF  HEALTH  37 

accurate  thermometer.  Clinical  thermometers,  as 
these  instruments  are  called,  are  made  entirely  of 
glass,  and  are  usually  furnished  in  the  shape  seen 
in  Fig.  4. 

This  instrument  is  graduated  according  to  the 
Fahrenheit  scale  and  provided  with  a  self -register- 
ing index,  which  is  simply  a  short  column  of  mercury 
separated  from  that  in  the  bulb  of  the  thermometer. 

Temperature  is  usually  taken  in  the  rectum  of 
the  infant  or  young  child,  and  in  the  mouth  of  a 
child  old  enough  to  understand  the  purpose  of  the 
procedure,  and  to  obey  directions  to  keep  the  lips 
closed,  the  tongue  over  the  bulb  of  the  instrument, 
and  to  avoid  breaking  the  glass  by  the  forcible 
closing  of  the  teeth. 

Supposing  the  rectum  be  chosen  as  the  place  of 
observation,  it  is  first  necessary  to  be  sure  that  this 
portion  of  the  gut  is  free  from  faeces.  The  upper 
end  of  the  stem  of  the  thermometer  is  then  held 
between  the  thumb  and  finger,  and  the  index,  by 
a  few  vigorous  shaking  movements,  is  forced  down 
so  far  that  its  upper  extremity  will  be  well  below 
the  normal  mark,  to  95°  for  instance;  next,  the  bulb 
is  covered  with  sweet  oil  or  vaseline  and  gently 
inserted  through  the  anus  into  the  rectum  for  a 
sufficient  distance  to  conceal  completely  the  mer- 
cury. Here  it  is  allowed  to  remain,  according  to  the 
sensitiveness  of  the  instrument,  from  one-half  to  two 


38  HYGIENE    OF    THE   NURSERY 

or  even  five  minutes  by  the  watch,  and  on  being 
removed  the  degree  of  temperature  is  read  from  the 
top  of  the  index.  The  position  of  the  patient  in  the 
meanwhile  is  upon  the  back,  on  the  nurse's  lap, 
with  the  legs  elevated  and  controlled  by  her  left 
hand,  the  right  hand  being  used  in  steadying  the 
thermometer. 

When  taking  the  temperature  in  the  mouth  direct 
the  child  to  lie  down  on  his  back  and  instruct  him 
not  to  bite  upon  the  delicate  glass.  Then,  having 
seen  that  the  instrument  is  thoroughly  clean  and 
that  the  top  of  the  index  is  below  the  normal  point, 
insert  the  bulb,  crosswise,  beneath  the  tongue.  The 
teeth  must  be  lightly  closed  so  as  to  hold  it  in 
position,  and  the  lips  closely  shut  about  its  stem. 
For  the  time  necessary  to  complete  the  observation 
breathing  must  be  performed  entirely  through  the 
nose. 

Temperature  is  also  taken  in  the  arm-pit  and 
groin,  but  the  observation  in  these  positions  is  inac- 
curate and  unreliable. 

One  more  fact  is  important,  namely,  that  a  simul- 
taneous observation  in  the  different  positions  men- 
tioned will  not  furnish  identical  results;  the  rectal 
and  oral  temperature  being,  normally,  at  least  i° 
higher  than  that  of  the  arm-pit,  and  1.5°  higher 
than  that  of  the  groin  in  the  same  individual. 

When  properly  used  the  thermometer  is  of  great 


THE   FEATURES    OF  HEALTH  39 

value  in  the  nursery.  At  the  same  time,  under  oppo- 
site conditions,  it  may  be  the  source  of  much  unnec- 
essary alarm  to  overanxious  parents.  To  prevent 
the  latter  misfortune,  all  who  intend  to  use  the 
instrument  should  be  familiar  with  the  healthy 
range  of  temperature  and  some  of  the  characteristic 
variations  in  disease. 

During  the  first  week  of  healthy  life  the  temper- 
ature fluctuates  considerably.  After  this  the  pu- 
erile norm — 98.5°  to  99°  F. — is  established,  but 
until  the  fourth  or  fifth  month  it  is  greatly  influenced 
by  physiological  causes  of  variation,  the  fluctuations 
ranging  between  .9°  and  3.6°.  By  the  fifth  month 
regular  morning  and  evening  oscillations  begin  to 
be  noticeable,  and  certain  definite  laws  are  followed. 
Thus  there  is  a  fall  in  the  evening  of  i°  or  2°.  The 
greatest  fall  occurs  between  7  and  9  p.  M.,  and  the 
minimum  is  reached  at,  or  before,  2  A.  M.  After 
2  A.  M.  there  is  a  gradual  rise,  the  maximum  being 
reached  between  8  and  TO  A.  M.  Throughout  the 
day  the  oscillation  is  trifling.  These  variations  are 
independent  of  eating  and  sleeping. 

It  may  be  taken  for  granted,  therefore,  that  a 
temperature  between  98°  and  99°  in  the  morning 
and  97.5°  and  98.5°  in  the  evening  is  the  range  to 
be  expected  in  a  healthy  child  beyond  the  age  of 
five  months. 

Examples  of  Variations  in  Disease. — In  disease 


4O  HYGIENE   OF   THE   NURSERY 

there  may  be  either  a  rise  above  or  a  fall  below  the 
normal  standard. 

Fever  is  always  associated  with  an  elevation. 
Rapid  and  transient  rises  attend  slight  catarrhs 
and  passing  indigestions.  Prolonged  rises  indicate 
inflammatory  and  essential  fevers,  for  example, 
typhoid,  scarlet  fever  and  measles. 

The  degree  of  elevation  marks  the  type  of  the 
fever.  This  is  moderate  when  the  mercury  stands 
at  102°,  severe  at  104°  or  105°,  and  very  grave 
above  107°.  It  is  known,  however,  that  infants 
are  extremely  sensitive  to  conditions  productive  of 
fever,  and  that,  in  them,  the  temperature,  like  the 
pulse,  is  easily  influenced  by  slight  and  transient 
causes:  therefore,  a  high  degree  of  temperature, 
I04°-io5°,  in  young  children  is  less  alarming  than 
in  adults,  and  of  less  import  than  a  continuance  of 
the  elevation,  in  estimating  the  gravity  of  a  fever. 
The  duration  of  the  elevation  and  the  peculiar 
range  of  the  oscillations  (for  there  are  oscillations 
in  disease  as  well  as  in  health)  determine  the 
nature  of  the  fever.  The  febrile  oscillations  differ 
from  the  healthy,  in  that  the  lowest  marking  is 
noticed  in  the  morning,  the  highest  in  the  evening. 

Variations  in  the  typical  range  of  any  given  fever 
are  important  prognostic  omens:  a  sudden  fall  of 
the  temperature,  together  with  improvement  in 
the  general  symptoms,  indicates  the  beginning  of 


THE    FEATURES    OF  HEALTH  41 

convalescence;  a  similar  fall,  with  an  increase  of 
the  general  symptoms,  is  a  precursor  of  death. 
When  the  morning  temperature  is  equal  to  that  of 
the  preceding  evening,  there  is  great  danger;  if 
higher,  greater  danger  still.  Marked  remission  in 
continued  fevers  is  generally  a  forerunner  of  con- 
valescence. 

Abnormal  depression  of  temperature  is  occasioned 
by  hemorrhage  and  by  the  loss  of  fluids  in  cholera 
infantum  or  entero-colitis.  It  is  also  met  with  in 
anaemia,  in  wasting  from  insufficient  nourishment, 
in  diseases  of  the  heart  and  lungs  attended  by  im- 
perfect oxidation  of  the  blood,  and  it  constantly 
attends  collapse  and  the  death  agony.  A  main- 
tained temperature  of  97°  is  dangerous  in  children, 
and  for  every  degree  of  reduction  below  this  the  risk 
for  life  is  more  than  proportionately  increased. 

14.  The  Mouth  and  Throat. — In  infants,  gentle 
pressure  of  the  fingers  upon  the  chin  is  sufficient  to 
cause  wide  opening  of  the  mouth.  An  older  child 
will  frequently  open  the  mouth  when  requested, 
but  if  he  refuses,  the  ringer,  or,  far  better,  the 
handle  of  a  spoon,  or  some  other  smooth,  flat  instru- 
ment, may  be  inserted  in  the  mouth,  and  downward 
pressure  made  upon  the  tongue,  when  the  jaws  will 
be  widely  separated.  In  some  cases,  when  the  child 
is  old  enough  to  do  as  he  is  bid,  the  fauces  can  be 
seen  by  directing  the  mouth  to  be  opened  wide  and 


42  HYGIENE   OF    THE   NURSERY 

the  tongue  to  be  alternately  protruded  and  retracted, 
or  a  prolonged  sound  of  "Ah"  to  be  made.  With 
the  refractory,  and  always  with  infants,  the  tongue 
has  to  be  held  down  by  a  spoon-handle  or  tongue- 
depressor.  If  there  be  resistance,  the  patient  must 
be  taken  on  the  lap  of  the  nurse,  who  holds  his 
back  against  her  breast,  directs  his  face  toward  a 
bright  light,  and  controls  the  movements  of  his 
hands  and  feet. 

The  healthy  oral  mucous  membrane  has  a  deep 
pink  color,  and  is  smooth,  moist  and  warm  to  the 
touch.  The  color  is  deeper  on  the  lips  and  cheeks, 
lighter  on  the  gums.  The  latter,  up  to  the  sixth 
month,  as  a  rule,  have  a  moderately  sharp  edge. 
Subsequently,  the  edge  begins  to  broaden  and 
soften,  and  the  color  of  the  investing  mucous  mem- 
brane deepens  to  a  vivid  red,  and  becomes  hot,  as 
the  teeth  begin  to  force  their  way  through. 

The  tongue  should  be  freely  movable.  It  is 
pink  in  color,  and  the  dorsum  or  upper  surface, 
marked  in  the  centre  by  a  slight  longitudinal  depres- 
sion, has  a  velvety  appearance,  and  is  soft,  moist  and 
warm  to  the  finger.  The  velvety  nap  is  due  to  the 
numberless  hair-like  processes  of  the  filiform  papil- 
lae. There  are  also  scattered  over  the  surface,  but 
most  closely  at  the  tip,  a  number  of  eminences,  the 
size  of  a  small  pin's  head,  circular  in  outline,  and 
deeper  pink  than  the  general  surface — the  fungi- 


THE    FEATURES    OF  HEALTH  43 

form  papillae.  While  far  back,  defining  the  papil- 
lary layer,  are  the  circumvallate  papillae,  numbering 
about  twelve,  and  arranged  in  a  V-shaped  row. 
These  have  the  form  of  an  inverted  cone,  sur- 
rounded by  an  annular  elevation. 

The  hard  palate,  or  roof  of  the  mouth,  is  rough- 
ened anteriorly  by  transverse  ridges.  The  soft 
palate — its  continuation — is  smooth,  and  its  mucous 
membrane  is  paler  than  that  of  the  rest  of  the  mouth. 
The  fauces,  or  walls  of  the  throat,  on  the  contrary, 
are  redder.  In  the  triangular  recess  between  the 
half  arches  of  the  palate  the  tonsils  can  always  be 
seen.  They  should  be  about  the  size  and  shape  of 
almond  kernels,  and  they  present  a  number  of  cir- 
cular openings,  the  orifices  6f  pouches,  into  which 
the  follicles  open.  The  uvula — or,  in  popular  lan- 
guage, the  palate — is  short  and  tongue-shaped. 
The  posterior  wall  of  the  throat  should  be  red, 
smooth  and  moist. 

Examples  of  Variations  in  Disease. — Fever  makes 
the  mouth  hot  and  dry,  and  causes  the  tongue  to  be 
frosted  or  coated.  Affections  of  the  stomach  and 
bowels  are  usually  attended  by  coating  of  the  tongue. 
Inflammation  of  the  mouth  itself  reddens  the 
lining  membrane,  makes  it  hot  and  tender  to 
the  touch,  increases  its  moisture,  alters  the  surface 
of  the  tongue  and  leads  to  the  formation  of  aphthae 
and  to  ulceration. 


44 


HYGIENE   OF   THE   NURSERY 


15.  Dentition. — Normally,  the  first  or  "milk 
teeth,"  twenty  in  number,  are  cut  in  groups,  each 
effort  being  succeeded  by  a  pause  or  period  of  rest. 
The  diagram  and  table  following  show  the  group- 
ing, the  date  of  eruption,  and  the  duration  of  the 


FIG.  5. — DIAGRAM  SHOWING  ERUPTION  OF  MILK  TEETH. 
i  i,  Between  the  4th  and  ?th  months.  Pause  of  3  to  9  weeks.  2222, 
Between  the  8th  and  loth  months.  Pause  of  6  to  12  weeks. 
33333  3, Between  the  i2th  and  isth  months.  Pause  until  the  i8th 
month.  4444,  Between  the  i8th  and  24th  months.  Pause  of  2  to 
3  months.  5555,  Between  the  2oth  and  3oth  months. 

pauses,  the  numbers,  i  to  5,  indicating  the  groups 
to  which  the  individual  teeth  belong  and  their  order 
of  appearance,  and  the  letters  a  and  b  the  prece- 
dence of  eruption  in  the  different  groups  (Fig.  5). 

The  pauses  are,  to  say  the  least,  most  helpful, 
giving  the  infant's  system  an  opportunity  to  rest 


THE   FEATURES    OF  HEALTH  45 

after  each  effort,  to  recover  from  any  coincident  ill- 
ness, and  to  prepare  for  the  next  strain. 

The  dates  here  given  show  the  time  within 
which  the  different  teeth  naturally  may  be  expected. 
In  regard  to  the  period  given  for  the  eruption  of  the 
lower  central  incisors,  1  would  state  that  the  fourth 
month,  although  an  early  is  not  a  very  rare  time 
for  their  appearance.  For  example,  I  have  seen 
during  one  winter  five  cases  in  which  these  teeth 
pierced  the  gum  at  this  age. 

Often  the  teeth  appear  without  the  production  of 
any  symptoms.  Sometimes  the  edges  of  the  gums 
lose  their  sharpness  and  become  swollen,  rounded, 
and  reddened  as  the  teeth  approach  the  surface. 
At  the  same  time  the  saliva  is  increased  in  quantity, 
and  the  mouth  is  unnaturally  warm  and  the  seat  of 
abnormal  sensations,  evidenced  by  the  tendency 
to  bite  upon  any  object  that  comes  to  hand — in 
other  words,  there  is  a  condition  of  mild  catarrhal 
stomatitis.  The  consequent  discomfort  is  not  suf- 
ficient to  interfere  with  the  child's  appetite,  good 
humor,  or  sleep,  and  when,  after  a  few  days,  the 
margin  of  the  tooth  is  free,  all  the  local  symptoms 
vanish. 

Examples  of  Variations. — Abnormal  dentition  is 
manifested  by  departures  from  the  laws  if  develop- 
ment already  stated.  The  standard  rules  may  be 
departed  from  in  three  ways: 


46  HYGIENE   OF   THE   NURSERY 

1 .  The  appearance  of  the  teeth  may  be  premature. 
Children  may  be  born  with  one  or  more  of  their 
teeth  already  cut;  these  are  usually  imperfect,  and 
soon  fall  out,  to  be  replaced,  at  the  proper  age,  by 
well-formed  milk  teeth.     Sometimes,  however,  they 
remain  permanently,  as  in  a  case  that  came  under 
my    own    observation.     Natal    teeth    are    always 
incisors.     Instances  of  the  lower  central  incisors 
being  cut  in  the  third  month  are  not  uncommon. 
Girls  are  more  apt  than  boys  to  cut  their  teeth 
early,  and,  as  an  early  dentition  is  likely  to  be  an 
easy  one,  the  occurrence  is  to  be  looked  upon  as 
fortunate. 

2.  Dentition  may  be  delayed.     This  deviation  is 
more  frequently  seen  and  of  more  consequence  than 
the  first.     Bottle-fed  babies,  as  a  class,  are  more 
tardy  in  cutting  their  teeth  than  those  reared  at  the 
breast.     With  such,   though  healthy  in  every  re- 
spect, a  delay  of  one  or  two  months  is  a  common 
and  not  at  all  serious  event.     On  the  contrary, 
whatever  the  method  of  feeding,  if  no  teeth  have 
appeared  by  the  end  of  a  year,  it  may  be  assumed 
that  the  child's  general  nutrition  is  faulty,  or  that 
rachitis   is   present.     Delay   does   not   necessarily 
imply  difficulty  in  cutting  the  teeth,  although  the 
two  conditions  are  often  associated. 

3.  The  teeth  may  appear  out  of  their  regular 
order.     Bottle-fed  infants  are  most  likely  to  show 


THE   FEATURES    OF  HEALTH  47 

this  irregularity,  which  is  of  some  importance  as  an 
indication  of  general  feebleness.  In  other  instances, 
however,  it  is  merely  a  family  peculiarity,  and,  as 
such,  bears  no  special  significance. 

The  order  of  eruption  of  the  permanent  teeth  is 
as  follows: 

The  two  central  incisors  of  lower  jaw,  from  6th  to  8th  year. 

The  two  central  incisors  of  upper  jaw,  from  yth  to  8th  year. 

The  four  lateral  incisors,  from  8th  to  gth  year. 

The  four  first  bicuspids,  from  gth  to  roth  year. 

The  four  canines,  from  loth  to  nth  year. 

The  four  second  bicuspids,  from  1 2th  to  13 th  year. 

These  replace  the  temporary  teeth;  those  which 
are  developed  de  novo  appear  thus: 

The  four  first  molars,  from  5th  to  yth  year. 
The  four  second  molars,  from  iath  to  13  th  year. 
The  four  third  molars,  from  i7th  to  2ist  year. 

There  are,  therefore,  twelve  more  permanent 
teeth,  making  thirty- two  in  all,  sixteen  in  each  jaw. 

The  diagram,  Fig.  6,  will  aid  in  explaining  the 
process. 

As  these  teeth  approach  the  surface,  absorption 
begins  in  the  alveoli  and  at  the  roots  of  the  deciduous 
teeth,  and  this  continues  until  the  latter  are  loosened 
and  readily  extracted,  or  if  this  be  not  done,  until 
little  is  left  but  their  crowns. 

When  the  first  and  second  molars  approach  the 
surface,  the  gums,  just  as  in  primary  dentition, 


48 


HYGIENE   OF   THE   NURSERY 


may  become  red,  swollen,  rounded,  and  tender. 
The  salivary  secretion  is  increased,  the  mouth  is 
hot,  the  patient  complains  of  aching  in  the  gum, 
and,  on  account  of  tenderness,  refuses  food  requir- 
ing mastication.  With  the  other  sets  there  is  a 
gradual  loosening  of  the  superimposed  temporary 


FIG.    6. — DIAGRAM    SHOWING   RELATION    BETWEEN   PERMANENT   AND 

TEMPORARY  TEETH. 

The  figures  i,  2,  3,  etc.,  indicate  the  groups  of  teeth  and  the  order  of  their 
appearance. 

teeth,  pain  on  mastication,  redness  and  tumefaction 
of  the  gum,  and  augmented  flow  of  saliva.  As 
there  is  no  impairment  of  the  general  health,  these 
trifling  symptoms  must  be  regarded  merely  as 
manifestations  of  the  progress  of  a  physiological 
process. 


THE    FEATURES    OF  HEALTH  4Q 

In  concluding  this  subject  it  is  important  to  em- 
phasize the  fact  that  many  diseases  occurring  in 
infancy  were  formerly  attributed  to  dentition,  but 
as  the  affections  of  early  life  have  been  more  care- 
fully studied  and  better  understood,  one  disorder 
after  another  has  been  relegated  to  its  proper  etio- 
logical  class,  and  teething  is  now  regarded  as  a 
purely  physiological  process,  unproductive  of  symp- 
toms. All  that  can  be  said  is  that  the  interval  be- 
tween the  fourth  and  thirtieth  months  of  an  in- 
fant's life — the  period  of  primary  dentition — is  an 
era  of  great  and  widely  extended  physical  progress. 
The  teeth  are  advancing;  the  follicular  apparatus 
of  the  stomach  and  intestinal  canal  is  undergoing 
development  in  preparation  for  the  digestion  and 
absorption  of  mixed  food;  the  cerebrospinal  system 
is  rapidly  growing  and  functionally  very  active,  and 
the  organs  and  tissues  of  the  whole  body  are  in  a 
state  of  active  change.  This  period  of  normal 
transition  must  also  be  one  in  which  there  is  great 
susceptibility  to  abnormal  change,  or  disease,  pro- 
vided there  be  a  causal  influence  at  work.  Such  an 
influence  usually  originates  outside  of  the  body,  as 
when  there  is  exposure  to  cold  or  to  contagion. 

Second  dentition,  has  perhaps  a  greater  but  still  a 
merely  indirect  effect  upon  the  health.  During  this 
process  the  loss  of  teeth  and  the  local  irritation  of 
the  gums  interfere  materially  with  mastication  of 

4 


50  HYGIENE    OF   THE   NURSERY 

the  older  child's  solid  food,  and  digestion  and 
nutrition  being  consequently  impaired,  the  general 
health  suffers  and  there  is  less  resistance  to  the 
various  external  causes  of  disease.  The  approach 
of  puberty  at  this  time  also  puts  an  additional  strain 
on  the  system. 


CHAPTER  II. 

THE  NURSERY. 

Every  well-regulated  house  in  which  there  are 
children  should  be  provided  with  two  nurseries, 
one  for  occupation  by  day,  the  other  by  night. 

Before  entering  further  into  the  subject,  how- 
ever, attention  must  be  directed  to  the  fact  that  the 
American  city-bred  child,  belonging  to  the  class  in 
which  it  is  possible  to  provide  separate  rooms  for 
nurseries,  is  to  a  greater  or  less  degree  a  migratory 
creature.  For  when  the  first  warm  days  of  May  or 
early  June  make  the  parents  bask  at  open  windows, 
the  child  is  hurried  off  to  a  suburban  hotel  or  f arm- 
House  or  to  the  sea-coast.  Again,  as  soon  as  the 
cold  evenings  of  late  September  suggest  the  com- 
fort of  an  open  fire,  equal  energy  is  exhibited  to 
get  him  back  to  cozy  winter  quarters.  In  summer, 
most  of  the  waking  hours  are  spent  in  the  open  air, 
in  winter,  the  greater  proportion  indoors;  hence 
the  day  nursey  must  be  regarded  as  a  winter  resort, 
and  as  such  must  possess  qualities  that  would  render 
it  uninhabitable  by  the  child  in  hot  weather.  The 
night  nursery  should  have,  though  to  a  much  less 
degree,  the  same  qualities.  In  other  words,  to  put 


52  HYGIENE   OF   THE   NURSERY 

the  whole  subject  concisely,  the  nurseries  for  winter 
use  should  be  warm  and  freely  exposed  to  the  sun; 
for  summer  use,  cool  and  rather  shaded,  though 
always  perfectly  dry. 

Since  the  child  spends  so  much  time  in  the  open 
air  during  warm  weather,  the  nurseries  will  be  dis- 
cussed in  this  chapter  purely  from  their  winter 
standpoint,  and  will  be  described  under  the  follow- 
ing heads: 

Situation. — Any  room  in  the  house  will  not  do 
for  a  day  nursery.  Rather,  on  the  contrary,  must 
the  best  room  be  selected.  It  should  have  a  south- 
west exposure,  and  be,  if  possible,  so  situated  in 
the  building  as  to  allow  of  at  least  two  broad  win- 
dows, one  in  the  southern  end  and  one  in  the  western 
side,  and  these  windows  must  always  be  strongly 
barred.  Into  such  a  room  the  sun  plays  with  full 
force  from  a  few  hours  after  rising  until  nearly  the 
time  of  setting.  The  third  floor  of  a  house  is  a 
better  elevation  for  the  nursery,  especially  if  there 
be  an  attic  above,  than  either  of  the  lower  floors, 
partly  because  such  rooms  are  remote  from  the 
ordinary  domestic  disturbances,  but  chiefly  because 
they  are  drier  and  more  readily  heated,  and  being 
elevated  are  less  cut  off  from  sunlight  by  surround- 
ing buildings. 

The  night  nursery  should,  if  possible,  adjoin  and 
communicate  with  the  day  nursery,  although  this 


THE   NURSERY  53 

feature  is  less  important  than  proximity  to  the 
parents'  sleeping-room.  It  should  have  a  good- 
sized  window  so  placed  that  it  will  freely  admit 
sunlight  during  the  day. 

When  the  nurseries  connect,  the  opening  of 
communication  must  be  capable  of  being  com- 
pletely closed  by  a  well-fitting  door  or  folding  doors, 
so  that  one  room  may  be  thoroughly  aired  with- 
out chilling  the  other. 

Neither  apartment  ought  to  communicate  with 
a  bath-room  having  sewer  connections;  in  fact, 
although  it  may  be  an  object  of  complaint  from  the 
nurse,  the  further  off  such  a  bath-room  is  the  better 
for  the  health  of  the  child. 

While  it  is  a  matter  of  difficulty  to  accomplish 
in  an  ordinary  city  house,  it  is,  nevertheless,  a 
necessary  thing  to  have  the  nurseries  in  close  prox- 
imity to,  or  even  in  communication  with,  the  apart- 
ment in  which  the  parents  sleep;  for  then  the  nurse 
is  forced  to  be  morally  purer  and  physically  more 
attentive  than  if  she  have  a  section  of  the  house  to 
herself. 

Many  mothers  prefer  to  keep  their  children  at 
night.  Under  this  condition,  the  bedroom  becomes 
the  night  nursery,  and  its  situation  must  be  as  care- 
fully selected,  and  its  hygiene  as  particularly  guard- 
ed, as  the  regular  night  nursery.  When,  too,  there 
are  several  children  in  the  family,  the  risk  of  over- 


54  HYGIENE    OF   THE   NURSERY 

crowding  in  such  apartments  must  be  recognized 
and  carefully  guarded  against.  The  factor  of  dis- 
turbed rest,  by  the  different  hours  of  retirement  of 
children  and  parents,  is  also  one  of  importance. 
On  all  of  these  accounts  a  night  nursery,  under  the 
control  of  a  competent  nurse,  is,  in  my  opinion,  to 
be  preferred. 

Size. — The  amount  of  atmospheric  air  required 
by  a  healthy  child  to  accomplish  thorough  oxida- 
tion of  the  blood  in  respiration  is  about  the  same 
as  that  demanded  by  adults.  Therefore  the  small- 
est admissible  room  for  either  a  day  or  night  nur- 
sery for  a  single  child  must  have  a  capacity  of 
eight  feet  cube.  For  more  than  one  child  the  rule 
ordinarily  given  is,  to  multiple  this  figure — eight 
feet  cube — by  the  number  of  individuals.  This 
rule  works  well  enough  for  a  family  of  two  or  three 
children,  but  if  the  number  be  greater,  the  size  of 
apartments  required  would  much  exceed  any  that 
could  be  found  in  ordinary  houses.  Lack  of  space, 
then,  must  be  made  up  by  more  perfect  methods 
of  ventilation.  To  put  the  question  in  a  more 
practical  form,  a  room  nine  or  ten  feet  high,  twenty 
feet  long  and  fifteen  feet  broad  will  readily  accom- 
modate, either  for  playing  or  sleeping  purposes, 
two  or  three  children,  with  one  attendant,  pro- 
vided foul  air  be  constantly  removed  and  fresh  air 
supplied  by  ventilation. 


THE   NURSERY  55 

In  every  room  the  undermost  stratum  of  air,  and 
the  one  in  which  the  child  must  pass  the  greater 
part  of  his  time,  whether  awake  or  asleep,  has  a 
much  lower  temperature  than  the  middle,  and  this, 
again,  than  the  highest,  the  tendency  of  the  heated 
air  being  always  to  rise  to  the  top.  Now,  the 
greater  the  height  of  the  apartment,  the  cooler  will 
be  the  floor  and  its  neighborhood;  consequently,  a 
lofty  ceiling — namely,  one  over  ten,  or,  at  most, 
twelve  feet — while  it  makes  an  imposing  show,  is 
far  from  being  desirable  for  a  nursery,  where  ease 
of  heating  and  the  comfort  and  health  of  the  occu- 
pants are  the  ends  to  be  attained.  On  the  other 
hand,  a  ceiling  less  than  eight  feet  high  will  tend 
to  make  the  room  close,  stuffy  and  overwarm,  and 
correspondingly  unhealthy. 

Lighting. — As  already  indicated,  the  only  per- 
missible light  for  a  day  nursery  is  that  derived  from 
the  sun,  and  the  more  plentiful  this  is,  and  the  more 
directly  it  enters,  the  better.  The  night  nursery 
may  be  illuminated  by  electricity,  by  gas,  by  an  oil 
lamp,  by  a  candle,  or  by  a  night  light.  Older  writers 
recommend  the  last  three,  upon  the  supposition 
that  gas,  while  burning,  not  only  consumes  a  con- 
siderable proportion  of  the  oxygen  of  the  air,  but 
gives  off  certain  injurious  products  of  combustion. 
This  may  be  true  to  a  certain  extent,  but  the  dis- 
advantages are  greatly  discounted  by  the  increase 


56  HYGIENE    OF   THE   NURSERY 

in  convenience  and  the  greater  safety,  so  far  as 
causing  fire  is  concerned. 

Gas,  or  much  better,  electricity,  certainly  may  be 
used  in  the  late  afternoon  and  evening.  During  the 
night  hours,  should  a  light  be  constantly  required, 
the  best  means  of  obtaining  it  is  from  one  of  the 
regular  night  lights. 

A  very  admirable  form  of  such  a  light  is  shown 
in  Fig.  7.  This  light,  called  the  "Pyramid  Night 


FIG.  7. — NIGHT  LIGHT. 

Light,"  consists  of  a  low  brass  stand  having  a 
movable  pyramidal  glass  chimney,  and  provided 
with  a  porcelain  cup  upon  which  the  candle  rests. 
The  candle  itself  is  about  one  inch  and  a  half  in 
height  and  breadth,  and  is  so  constructed  that  the 
combustible  material  is  completely  incased  in  a 
fireproof  plaster-of-Paris  cup.  Each  candle  will 
burn  eight  or  ten  hours.  These  lights  are  perfectly 


THE   NURSERY  57 

safe  and  may  be  utilized  for  the  further  purpose  of 
keeping  water  warm. 

For  occasional  use  at  night,  nothing  can  be 
better  or  of  more  ready  service  than  electricity  or  gas. 

The  safest  way  to  make  a  light  is  to  use  a  safety- 
match.  The  taking  of  a  flame  from  an  open  fire 
or  the  use  of  ordinary  friction  matches  are  danger- 
ous and  to  be  strongly  discouraged. 

Furnishing. — This  heading  may  be  made  to 
include  the  finish  of  the  floor,  walls  and  ceiling,  as 
well  as  the  necessary  articles  of  furniture  and  their 
arrangement. 

The  floor,  which  ought  to  be  laid  with  good 
yellow  pine  boards,  should  have  a  hard  finish.  To 
accomplish  this,  the  crevices  between  the  boards 
and  all  the  nail  holes  must  first  be  filled  with  putty, 
then,  after  this  has  dried,  coated  with  a  rapidly- 
drying,  hard  shellac  varnish,  next  sandpapered, 
when  the  varnish  has  had  time  to  harden  thor- 
oughly, and,  finally,  finished  by  a  second  coat  of 
shellac.  This  gives  a  light-colored  floor  that  bright- 
ens the  room  and  at  the  same  time  is  readily  cleaned. 
A  dark  staining,  besides  being  sombre,  always  looks 
soiled.  A  painted  floor  is  not  easily  cleaned. 
Should  either  of  the  latter  be  already  in  a  nursery, 
their  defects  may  be  overcome  by  a  well-laid 
parquet  floor. 

A  carpet  tacked  to  the  floor  is  not  to  be  recom- 


58  HYGIENE    OF    THE   NURSERY 

mended;  far  better  is  it  to  have  rugs,  which  can  be 
frequently  taken  up  and  well  shaken,  the  house- 
maid having  in  the  meanwhile  free  access  to  the 
floor  itself. 

Paint  is  the  best  finish  for  the  walls.  Individual 
taste  will  of  course  weigh  in  the  selection  of  the 
color  and  amount  of  decoration,  though  a  light  tint, 
but  still  one  not  trying  to  the  eyes,  is  most  desirable. 
Next  to  paint,  varnished  paper  is  to  be  preferred. 
Within  the  past  few  years  light  and  soft-tinted 
fabrics,  covered  with  the  representations  in  figure 
of  familiar  nursery  legends,  have  been  for  sale  by 
paper  dealers.  Such  papers  render  the  nursery 
attractive  to  older  children,  and,  to  a  "great  extent, 
take  the  place  of  pictures.  Paint,  however,  has  the 
advantage,  in  that  it  may  be  washed  and  thoroughly 
disinfected  in  case  of  the  occurrence  of  contagious 
disease. 

To  return  to  the  subject  of  pictures,  it  is  best  to 
interdict  any  that  are  valuable  or  expensively 
framed.  A  few  well-colored,  striking,  prints  taken 
from  one  of  the  good  weekly  illustrated  papers, 
and  fixed  to  the  painted  wall  by  glue,  will  give  as 
much  pleasure  to  the  childish  eyes  as  the  works  of 
the  best  artists.  They  can,  too,  be  changed  from 
time  to  time,  and  after  exposure  to  contagious  germs 
may,  without  regret,  be  removed  and  burned  in  the 
process  of  cleaning. 


THE   NURSERY  59 

The  ceiling  of  the  rooms  should  always  be  painted 
with  some  light  color,  and  be  perfectly  free  from 
ornamentation. 

In  the  matter  of  furniture,  the  windows  of  the  day 
nursery  should  be  fitted  with  dark  shades,  but 
never  with  curtains  or  hangings.  In  summer  when 
the  windows  are  often  open,  they  must  be  carefully 
screened  to  keep  out  insects,  especially  mosquitoes 
and  flies.  These  not  only  annoy  the  child',  but  the 
mosquito  may  introduce  the  germ  of  malaria  or 
poison  with  its  sting,  and  the  feet  of  the  fly  may 
carry  the  germs  of  such  diseases  as  typhoid  fever, 
diphtheria  or  tuberculosis.  Other  furnishings  are : 
a  table,  at  which  the  older  children  may  take  their 
meals  or  use  in  play  and  study;  one  or  more  large 
chairs  and  several  small  ones;  a  plentiful  supply 
of  toys  and  picture  books,  and,  if  there  be  room 
enough,  a  chest  of  drawers  or  wardrobe  for  clothing, 
and  so  on.  All  the  furniture  must  be  plain,  that 
it  may  be  more  easily  kept  clean. 

The  center  of  the  room  must  be  kept  clear,  to 
give  an  opportunity  for  play.  The  table,  therefore, 
should  be  a  folding  one,  that  it  may  be  placed  out 
of  the  way  against  the  wall  and  take  up  the  least 
space  possible  when  not  in  use.  Any  other  heavy 
article  of  furniture  must  also  occupy  a  position 
against  the  wall  and  be  fitted  with  casters,  so  that 


60  HYGIENE   OF   THE   NURSERY 

it  can  be  readily  moved  to  facilitate  cleaning  the 
floor  beneath. 

The  toys  may  vary  in  character  with  the  age  of 
the  child — soft,  white  India-rubber  ones  for  infants, 
more  complicated  mechanisms  for  older  children; 
but  inexpensive  toys  are  the  best,  because  they  can 
be  more  frequently  changed.  The  same  is  true  of 
books.  For  both,  by  the  way,  there  should  be  a 
special  drawer  or  closet  provided,  where  they  can 
be  put  out  of  the  way  when  not  required. 

A  few  plants,  a  bird,  or  a  globe  of  fish  add  bright- 
ness to  the  child's  room  and  greatly  assist  in  culti- 
vating good  taste  and  in  affording  amusement. 

The  night  nursery  must  contain  the  beds,  the 
bathing  and  toilet  utensils,  several  chairs — one 
being  a  rocker — a  small  table,  a  medicine  closet 
and  a  chest  of  drawers  or  other  convenient  recep- 
tacle for  clothing  and  extra  bed  covering. 

It  is  essential  to  have  a  separate  bed  for  the  nurse 
and  one  for  each  child.  They  should  be  placed  so 
as  to  be  protected  from  any  chance  draught  of  air, 
be  far  enough  apart  to  allow  of  a  free  passage  be- 
tween; and  the  bed  of  the  youngest,  or  of  an  ill  child, 
ought  to  be  nearest  the  one  belonging  to  the  nurse. 
About  these  beds  nothing  that  may  not  be  washed 
can  be  allowed. 

Old-fashioned  pitchers  and  basins  are  to  be  pre- 
ferred to  stationary  washstands.  The  latter,  though, 


THE   NURSERY  6 1 

are  so  convenient — especially  when  supplied  with 
hot-  and  cold-water  faucets — that  they  may  be  per- 
mitted when  the  waste  pipe  is  short  and  runs  directly 
through  the  wall  into  a  rain  spout,  instead  of  com- 
municating with  the  sewer,  and  when  the  nurse 
can  be  trusted  not  to  use  them  as  a  convenient 
means  of  disposing  of  the  ordinary  chamber 
waste. 

Each  child  should  have  his  or  her  own  brushes, 
combs,  sponges,  soap  and  towels,  and  all  of  them 
must  be  kept  clean  and  sweet  and  have  a  place  of 
their  own. 

The  medicine  closet  must  contain  only  such 
articles  as  may  be  often  required,  and  can  be  used 
with  safety  by  a  person  of  average  intelligence;  for 
example,  olive  oil,  vaseline,  oxide  of  zinc  ointment, 
talcum  powder,  soda-mint,  sweet  spirits  of  nitre, 
syrup  of  ipecacuanha,  chalk  mixture,  etc.  Any 
preparation  containing  opium — even  paregoric — 
is  especially  out  of  place  in  the  nursery  medicine 
chest. 

Feeding  bottles,  implements  for  the  heating  and 
preparation  of  food  and  for  bathing,  also  belong  to 
the  furniture  of  the  nurseries,  but  their  consideration 
may  be  conveniently  postponed  to  later  sections. 

Heating. — Each  room  requires  an  accurate  ther- 
mometer, so  hung  that  it  may  record  the  mean  tem- 
perature— not  too  close  to  the  fireplace  or  the  win- 


62  HYGIENE   OF   THE   NURSERY 

dows,  where  it  runs  the  chance  of  being  unduly 
heated  or  chilled. 

The  temperature  of  the  day  nursery  should  range 
between  68°  and  70°  F. ;  that  of  the  night  nursery 
from  64°  to  68°  for  infants  under  three  months  old; 
after  the  third  month  a  temperature  of  55°  is  allow- 
able, and  when  the  child  is  a  year  old  it  may  be  as 
low  as  50°  or  45°. 

The  proper  method  of  heating  is  by  an  open  fire- 
place in  which  either  wood  or  coal  is  burnt.  Either 
of  these  fires  is  superior  to  a  furnace,  simply  because 
they  serve  a  double  purpose,  namely,  heating  and 
ventilating.  My  personal  preference  is  for  an  old- 
fashioned  hearth,  where  oak  or  other  quietly  burn- 
ing logs  can  be  used,  since  a  wood  fire  is  more 
readily  lighted  and  regulated,  and  is  a  better  venti- 
lator than  one  of  coals.  Still,  in  our  climate,  with 
its  manifold  and  sudden  changes,  it  is  so  jessential 
to  have  a  source  of  heat  constantly  at  hand  that  it 
is  difficult  to  banish  the  furnace  register  from  any 
living  room.  Therefore,  while  recognizing  the  dis- 
advantage of  furnace  heat,  in  that  it  makes  the  air 
too  dry,  it  is  well  to  supply  the  nurseries  with  both 
means  of  heating,  using  the  open  fire  in  moderate 
weather  and  the  furnace  only  in  the  presence  of 
severe  cold.  For  general  heating  the  modern  hot- 
water  radiating  system  is  to  be  much  preferred  to 
the  old  hot-air  furnace  and  to  steam  heating;  with 


THE   NURSERY  63 

it,  an  even  temperature  is  easily  secured  without 
over-drying  the  air  of  the  house,  or  loading  it  with 
dust  and  coal-gas. 

In  my  experience,  where  the  nurseries  are  so 
situated  as  to  receive  direct  sunlight  through  ample 
windows,  there  is  rarely  any  need  of  furnace  heat 
except  in  the  early  morning,  before  the  servants 
have  time  to  make  up  the  wood  or  coal  fire. 

Care  must  be  taken  to  guard  every  open  fireplace 
with  a  high  fender,  one  that  can  neither  be  knocked 
down  nor  climbed  over  by  an  active  child. 

Ventilation. — In  addition  to  furnishing  ample 
space  in  the  nurseries,  it  is  necessary  to  provide  a 
constant  supply  of  fresh  air  by  ventilation. 

By  all  odds  the  best  ventilator  is  an  open  fireplace 
in  which  wood  is  burnt.  Such  a  fire,  by  creating  a 
draught  up  the  chimney,  carries  off  the  impure  air, 
and  there  are  few  doors  and  windows  so  closely 
fitting  that  they  prevent  the  entrance  of  fresh  air 
to  supply  the  place  of  that  so  removed. 

Should  this  not  prove  sufficient,  one  of  the  windows 
may  be  utilized,  the  upper  sash  being  slightly 
lowered  and  the  lower  sash  slightly  raised,  the  open- 
ings being  sufficient  to  allow  of  the  entrance  and 
exit  of  air,  but  not  enough  to  cause  a  current  or 
draught  in  the  room. 

When  the  rooms  are  heated  by  a  furnace  or  stove, 
some  permanent  ventilator  must  be  used.  For  the 


HYGIENE   OF   THE   NURSERY 


egress  of  foul  air  an  opening  may  be  made  in  the 
chimney  at  a  convenient  distance  from  the  floor; 
this  may  be  guarded  by  an  ordinary  adjustable 
register,  such  as  is  used  to  regulate  the  entrance  of 
heated  air  from  a  furnace  flue. 

The  same  purpose  may  also  be  accomplished  by 
making  an  opening  in  the  upper  part  of  the  door. 
This  should  be  guarded  by  a  movable  sash,  or  by 
one  of  the  ventilating  appliances  to  be  mentioned 
later. 


FIG.  8. — WINDOW  VENTILATOR. 

To  allow  of  the  free  entrance  of  pure  air,  one  of 
the  glass  lights  may  be  replaced  by  a  plate  of  tin 
having  a  multitude  of  minute  perforations,  or  a 
ventilator  made  to  fit  the  window  may  be  used. 

The  best  of  these  are  shown  in  the  four  following 
figures. 

One  apparatus  (Fig.  8)  consists  of  two  pieces  of 
board,  one  of  which  slides  upon  the  other,  so  that 
it  may  be  readily  adapted  to  any  breadth  of  win- 


THE   NURSERY  65 

dow  frame.  Each  portion  has  a  circular  opening 
to  which  is  fitted  a  tin  or  sheet-iron  pipe,  eight 
inches  long  by  four  inches  in  diameter,  and  having 
a  slight  upward  bend.  These  pipes  are  provided 
with  a  solid  diaphragm  (Fig.  9)  readily  moved  by  a 
handle,  and  intended  to  regulate  the  quantity  of  air 
admitted.  When  in  position  the  pipes,  of  course, 
project  inward. 


FIG.  9. — WINDOW  VENTILATOR  IN  PROFILE  SHOWING  DAMPER. 

The  wheel  window  ventilator  (Fig.  10)  consists  of 
a  movable  diaphragm  and  a  revolving  wheel,  the 
whole  varying  from  six  to  eight  inches  in  diameter. 
When  placed  in  position,  which  is  readily  done  by 
cutting  a  circular  hole  in  a  window  pane  or  in  the 
door,  the  difference  in  temperature  between  the 
interior  and  exterior  of  the  room  will  create  a 
current,  and  cause  the  wheel  to  revolve  noiselessly. 
5 


66 


HYGIENE   OF   THE   NURSERY 


The  revolving  wheel,  while  it  prevents  a  draught, 
allows  of  the  passage  of  two  currents,  that  of  fresh 
air  inward  and  foul  air  outward,  and  the  diaphragm 
enables  one  to  control  the  supply  of  air. 


FIG.  10. — WHEEL  VENTILATOR. 


FIG.  ii. — BOARD  VENTILATOR  IN  PLACE. 

An  admirable  domestic  arrangement  for  ventila- 
tion consists  of  a  board  eight  or  ten  inches  in  height 
placed  across,  and  close  to,  the  window  sill,  as  in 
Fig.  ii. 


THE   NURSERY  67 

This,  when  the  lower  sash  is  raised,  as  indicated 
by  the  dotted  lines,  allows  of  a  free  entrance  of  air 
without  a  draught,  the  current  being  directed  up- 
ward (as  shown  by  the  arrows). 

Together  with  the  above  careful  provision  for 
constant  purification  of  the  atmosphere,  it  is  essen- 
tial to  "  air"  thoroughly  both  of  the  nurseries  through 
widely  opened  windows.  With  the  day  nursery 
this  must  be  done  whenever  the  child  leaves  it  for 
any  length  of  time,  care  being  taken  to  close  the 
windows  and  get  the  temperature  to  the  proper 
degree  before  his  return.  The  night  nursery  should 
be  aired  after  the  children  leave  it  in  the  morning, 
and  after  the  midday  nap. 

The  air  of  the  nurseries  should,  of  course,  never 
be  unnecessarily  contaminated.  Cooking  or  smok- 
ing in  the  rooms  is  to  be  specially  avoided.  In 
regard  to  the  latter,  there  is  no  doubt  that  children 
are  often  made  sick  by  the  fumes  of  tobacco,  and 
that,  of  all  forms,  cigarette  smoke  is  the  most  in- 
jurious. 

Cleaning. — It  is  hardly  necessary  to  say  that  the 
nurseries  must  be  kept  perfectly  clean.  Napkins 
and  bed  clothing  that  have  been  soiled  by  the  dis- 
charges from  the  bladder  or  bowels  must  be  re- 
moved at  once  from  the  room,  and  the  practice  of 
hanging  diapers  wet  with  urine  before  the  nursery 
fire  to  dry  should  be  emphatically  discouraged. 


68  HYGIENE   OF   THE  NURSERY 

Equal  care  must  be  taken  to  promptly  empty  and 
clean  chamber  vessels  after  use. 

The  furniture,  woodwork  and  window  glass,  as 
well  as  the  floors,  must  be  kept  clean  and  free  from 
dust  by  wiping  with  a  damp  cloth  at  least  once  or 
twice  a  week. 

Should  there  be  a  stationary  washstand  in  either 
room,  it  is  most  important  to  thoroughly  clean  the 
basin  every  day,  and  to  disinfect  the  waste  pipe,  how- 
ever short  it  may  be,  twice  every  week.  The  latter 
may  be  done  with  ammonia,  copperas  or  Platt's  chlo- 
rides. The  process  is  very  simple,  and  consists  in 
pouring  down  the  pipe  a  gallon  or  more  of  a  diluted 
solution  of  either  of  the  above  articles.  Copperas 
is  the  cheapest  and  in  my  opinion  the  best;  a  double 
handful  of  it  in  an  ordinary  bucketful  of  water 
forms  an  efficient  disinfectant  and  deodorizer. 

The  substance  known  as  household  ammonia 
may  be  employed  in  the  strength  of  two  table- 
spoonfuls  to  a  gallon  of  water,  and  is  especially 
useful  where  there  is  a  suspicion  that  the  interior 
of  the  waste  pipe  has  become  coated  with  a  layer 
of  soap. 

Platt's  chlorides  is  used  in  the  proportion  of  one 
part  to  four  of  water,  and  is  very  efficient,  though 
more  expensive  than  either  of  the  other  materials. 

The  nurseries  must  never  be  cleaned  while  the 
children  are  occupying  them. 


CHAPTER  III. 

THE  NURSE-MAID. 

While  the  mother  is  the  natural  guardian  of  the 
physical  and  moral  welfare  of  her  children,  the 
nurse-maid  has  a  considerable  influence  over  both; 
for  the  former,  however  anxious  and  watchful,  has 
so  many  other  duties,  both  domestic  and  social, 
that  she  must  absent  herself  at  times  from  the 
nursery;  the  latter,  on  the  contrary,  lives  there. 
By  day,  and  often,  too,  at  night,  she  has  the  care 
of  the  children,  attending  to  their  apartments,  to 
their  persons,  food  and  clothing,  participating  in 
their  amusements  and  exercise,  and  watching  over 
their  sleep.  The  selection  of  a  nurse-maid,  there- 
fore, is  a  matter  of  much  importance. 

The  celebrated  Dr.  West,  in  discussing  the  nurs- 
ing of  sick  children,  makes  the  following  statement 
in  regard  to  a  nurse's  qualifications:  "Indeed,  if 
any  of  you  have  entered  on  your  office  (hospital 
nursing)  without  a  feeling  of  very  earnest  love  to 
little  children — a  feeling  which  makes  you  long 
to  be  with  them,  to  take  care  of  them,  to  help 
them — you  have  made  a  great  mistake  in  under- 


70  HYGIENE    OF   THE   NURSERY 

taking  such  duties  as  you  are  now  engaged  in." 
Now,  though  this  was  addressed  to  those  who  were 
occupied  in  caring  for  ill  children,  it  is  alike  appli- 
cable to  the  nurse  whose  chief  duties  are  with  the 
healthy. 

Love  of  children,  therefore,  is  essential  in  a  good 
nurse,  but  it  must  be  combined  with  several  other 
traits  of  character,  since  love  alone  will  not  com- 
pensate for  such  faults  as  stupidity,  inexperience, 
forgetfulness  and  lack  of  judgment. 

What,  then,  are  the  qualifications  to  be  sought 
for? 

First. — The  woman  should  be  in  the  prime  of  life, 
between  twenty-five  and  sixty,  for  example.  For  if 
she  be  under  the  former  age,  she  is  apt  to  be  frivo- 
lous and  think  more  of  her  " afternoon  out"  and  of 
her  male  friends  than  of  her  charge,  while  if  over 
the  latter,  besides  being  set  in  her  ways  and  opin- 
ionated, she  is  usually  too  worn  out  for  efficient  day 
service  and  too  prone  to  heavy  steeping  to  be  trusted 
for  night  duty. 

Second. — Strength,  activity  and  freedom  from  dis- 
ease are  necessary.  Consumption  of  the  lungs,  indi- 
cated by  a  cough,  and  syphilis,  indicated,  usually,  by 
an  eruption  upon  the  skin,  are  two  diseases  to  be 
specially  avoided.  Besides  these  two,  which  are  to 
be  shunned  because  they  positively  endanger  the 
child's  health,  there  are  others  that,  without  doing 


THE   NURSE-MAID  71 

appreciable  harm,  render  the  sufferer's  presence  un- 
bearable in  the  nursery.  These  chiefly  offend 
through  the  sense  of  smell,  as  in  the  case  of  old 
leg  ulcers;  too  freely  perspiring  feet;  overactive 
axillary  glands;  certain  forms  of  chronic  catarrh 
of  the  nose,  throat  or  tonsils;  and  of  decayed  or 
badly  kept  teeth. 

Third. — While  beauty  is  not  to  be  specially  sought 
after,  the  maid's  face  should,  at  least,  have  a  cheer- 
ful expression.  A  markedly  homely  or  sinister 
face  is  a  disadvantage,  and  still  more  so  is  any 
decided  deformity.  This  reference  to  personal 
appearance  at  first  sight,  perhaps,  seems  trivial, 
but  any  one  who  has  seen  much  of  children  can- 
not fail  to  have  noticed  how  a  young  child  will 
crow  and  hold  out  its  arms  to  one  who  has  a  placid, 
comely  and  smiling  face,  and  turn  away  from  one 
who  wears  a  sombre  and  unsympathetic  expression. 
Much  is  said  about  the  magic  of  touch  in  managing 
young  children,  but  I  have  observed  that  their  eyes 
always  seek  the  face  and  eyes  of  those  about  them, 
and  that  it  is  what  they  see  there  that  guides  their 
instinct  for  like  or  dislike. 

Fourth. — Children  resemble  dogs  and  horses  as 
far  as  the  instinct  of  knowing  those  who  love  them  is 
concerned,  and  the  element  of  love  toward  babies 
is,  as  already  hinted,  the  most  important  feature  in 
the  disposition  of  a  nurse.  A  woman  having  this 


72  HYGIENE   OF   THE   NURSERY 

quality  will  never  be  cross  or  impatient,  and,  by  the 
very  contagion  of  her  good  nature,  prevents  her 
charges  from  being  fretful  and  makes  her  nursery 
happy.  Besides  love,  with  the  patience  and  con- 
sideration it  implies,  truthfulness  is  a  most  impor- 
tant trait  of  character,  not  only  for  the  physical 
welfare  of  the  child,  but  also  that,  since  children 
are  such  imitative  creatures,  the  bad  habit  of  lying 
may  not  be  formed. 

A  truthful,  loving  woman  is  generally  a  cheerful 
one;  if  not,  her  place  is  out  of  the  nursery,  for 
children  must  be  happy  to  be  healthy,  and  the 
constant  contact  with  sadness  will  bring  unhappi- 
ness  to  any  child. 

Gentle  speech  is  also  a  desideratum.  Children 
will  never  learn  politeness  if  every  sentence  they 
hear  in  the  nursery  is  spoken  in  the  fewest,  shortest 
words;  and  "please"  and  "thank  you"  are  good 
elements  of  a  nurse's  conversation. 

Fifth. — The  nurse-maid  should  have  a  sufficiently 
developed  mind  to  follow  out  and  remember  gen- 
eral directions,  whether  given  by  the  physician  or 
mother,  and  to  do  routine  work  without  constant 
supervision.  A  certain  amount  of  experience  is  a 
good  thing,  and  on  this  account  it  is  recommend- 
ation for  a  woman  to  have  had  a  partial  hospital 
training,  to  have  nursed  children  before,  or  to  have 
been  a  mother.  On  the  other  hand,  one  must 


THE   NURSE-MAID  73 

beware  of  the  self-opinionated  maid,  who,  having 
cared  for  several  children,  thinks  she  knows  every- 
thing, and  will  be  controlled  by  neither  professional 
nor  maternal  directions.  Such  women  are  as  igno- 
rant and  inefficient  as  they  are  common. 

Sixth. — Cleanliness  is  essential  in  a  nurse.  A 
slovenly  maid  will  keep  neither  her  children  nor 
their  nurseries  clean.  Therefore,  insist  upon  the 
nurse  not  only  washing  her  face  and  hands  as  oc- 
casion requires,  but  upon  her  bathing  her  whole 
body  frequently,  and  upon  her  wearing  fresh,  well- 
aired  clothing. 

Seventh. — So  far  as  habits  are  concerned,  absolute 
temperance  and  early  rising  are  the  most  desirable. 
Early  rising,  however,  implies  an  early  hour  of 
retiring,  and  care  must  be  taken  to  afford  ample 
facilities  for  so  doing. 

Eighth. — Every  nurse-maid  should  be  impressed 
with  the  importance  of  informing  the  parents  of  all 
conditions  connected  with  the  health  of  the  child  that 
may  demand  attention,  and  of  revealing  at  once 
any  injury  that  may  have  been  sustained. 

Having  selected  a  nurse-maid  with  due  care,  the 
mother  must  remember  that  she  is  not  absolved 
from  her  duty  of  supervision  and  assistance  in  the 
nursery.  The  best  of  nurses  will  do  better  work, 
and  be  more  happy  and  hence  more  useful  if 
intelligently — not  naggingly — overlooked,  and  so 


74  HYGIENE   OF   THE   NURSERY 

assisted  as  not  to  be  hurried  in  such  necessary  sup- 
plemental work  as  washing  napkins  and  cleaning 
the  nursery,  if  her  meals  can  be  taken  at  regular 
hours  and  in  sufficient  leisure,  and  if  she  be  allowed 
reasonable  time  for  relaxation  and  rest.  All 
this  may  be  accomplished  if  the  mother  will  take 
charge  of  her  child  for  a  few  hours  each  day,  and, 
by  so  doing,  perform  a  duty  which  is  of  mutual 
benefit  to  herself  and  her  baby,  and  which  should  be 
nothing  but  an  extreme  pleasure. 


CHAPTER  IV. 

CLOTHING. 

In  introducing  this  subject,  it  may  be  well  to  call 
attention  to  two  important  points  that  are  often 
either  unrecognized  or  overlooked. 

First. — All  children,  but  particularly  infants,  have 
little  power  to  resist  the  depressing  influences  of 
continued  cold,  and  on  this  account  require  warm 
clothing. 

Too  much  cannot  be  said  against  the  fashion 
which,  for  the  sake  of  supposed  beauty,  demands 
that  children  should  be  dressed  in  a  way  to  leave 
their  legs  and  knees  bare.  Even  in  the  house,  and 
except  in  extreme  tropical  weather,  this  barbarous 
practice  is  injurious,  as  it  exposes  a  considerable 
part  of  the  body  to  constant  chilling.  The  physician 
knows,  and  the  intelligent  layman  should  be  readily 
convinced  of,  the  bad  effects  of  such  protracted 
abstraction  of  body-heat.  The  explanation  is  sim- 
ple: every  child  is  supplied  by  nature  with  a  certain 
definite  quantity  of  nerve  force  destined  to  be  ex- 
pended each  day  in  maintaining  what  physiologists 

75 


76  HYGIENE    OF   THE   NURSERY 

term  "the  functions  of  the  body,"  namely,  breathing, 
circulation  of  the  blood,  digestion,  heat-production, 
and  so  on.  Now,  if  an  undue  proportion  of  this 
nerve  force  be  consumed  in  producing  body-heat, 
as  must  be  the  case  when  so  large  a  surface  is  left 
bare,  the  other  functions  will  be  robbed  of  force. 
From  this  robbery  the  digestion  suffers  most.  With 
feeble  digestion  comes  constipation  or  its  opposite, 
diarrhoea.  Again,  if  the  surface  be  chilled,  the 
blood  which  should  circulate  in  the  skin  is  driven 
to  the  interior  of  the  body,  and  the  vessels  of  the 
mucous  membrane  become  surcharged.  This  sur- 
charging, or  congestion,  causes  the  condition  known 
as  catarrh,  which,  affecting  the  lining  membrane 
of  the  alimentary  tract,  causes  vomiting  and  diar- 
rhoea; and,  in  the  case  of  the  lungs,  bronchitis. 

Mothers  who  allow  their  children  to  have  their 
legs  and  knees  covered  with  the  "hideous"  long 
stockings  or  drawers,  often  come  to  me  and  complain 
that  Mrs.  So-So's  children  have  bare  legs,  and  are 
even  healthier  and  more  robust  looking  than  theirs. 
Some  children  are  born  hardier  than  others,  but 
no  one  knows,  in  the  long  run,  how  much  better 
in  health,  in  after  life,  are  those  whose  vital  forces 
have  been  husbanded  and  strengthened  in  infancy 
and  childhood.  I  cannot  waver  in  my  opinion.  I 
have  been  too  often  called  to  the  bedside  of  these 
poor  little  "robust"  children  whose  health,  and  even 


CLOTHING  77 

life,  might  have  been  spared  had  their  clothing  been 
better  adapted  to  their  tender  years.  One  great 
argument  advanced  by  the  advocates  of  bare  knees 
is  that  in  olden  times  all  children  were  clad  with 
their  arms  and  neck,  as  well  as  knees,  bare.  No 
one  says  how  many  died  by  the  wayside.  What 
mother  would,  on  a  winter's  day,  care  to  sit  on  the 
floor  or  walk  through  the  halls  with  her  knees  un- 
covered? The  mother  who  protests  the  loudest  I 
have  always  observed  to  be  warmly  dressed  herself. 

Second. — Infants  and  children  have  soft  tissues. 
This  statement  applies  as  well  to  the  bones  as  to 
the  muscles.  Therefore,  the  clothing  should  fit 
loosely,  that  it  may  not  interfere  with  the  motion  of 
the  limbs,  with  the  rise  and  fall  of  the  chest  in  respi- 
ration, or  with  the  necessary  freedom  of  the  muscles 
of  the  abdominal  wall  or  intestinal  canal,  one  of 
which  is  concerned  in  respiration,  the  other  in  the 
no  less  important  function  of  digestion. 

Let  the  clothing,  then,  be  warm  and  loose. 

Thought  for  the  infant's  clothing  must  begin 
before  its  birth,  with  the  filling  of  the  "baby's  bas- 
ket." This  should  contain  the  following  articles: 

A  nainsook  slip. 

A  flannel  skirt. 

A  merino  shirt,  high  neck  and  long  sleeves. 

A  flannel  band,  twenty  inches  long  and  five  inches 
wide. 


78  HYGIENE   OF   THE   NURSERY 

A  soft  woolen  shawl,  to  be  used  for  a  wrap  in  cold 
weather. 

Worsted  socks. 

Two  linen  diapers. 

Large  and  small  safety-pins. 

One  pair  blunt-pointed  scissors. 

Powder  box  and  puff. 

Soft  hair  brush. 

Cold  cream  or  white  vaseline. 

Linen  bobbin. 

Two  soft  towels. 

Castile  soap. 

Small  soft  flannel  wash  cloths,  for  washing  face 
and  head. 

Small  silk  sponge,  for  bathing  body  and  limbs. 

Absorbent  cotton  for  cleansing  mouth,  eyes, 
genital  organs  and  buttocks. 

As  soon  as  the  child  is  born  and  the  cutting  of 
the  cord  frees  it  from  maternal  connection,  it  is  the 
rule  to  wrap  it  in  a  piece  of  soft  flannel  and  place 
it  in  a  position  of  safety  until,  certain  necessary 
attentions  having  been  rendered  to  the  mother,  a 
convenient  time  arrives  for  washing.  After  this 
operation,  which  will  be  described  on  a  future  page, 
the  child  is  dressed  for  the  first  time.  Every  infant 
requires  knitted  worsted  shoes,  or,  as  they  are 
popularly  called,  "socks,"  a  napkin  and  an  abdom- 
inal band  or  " binder";  the  rest  of  the  dress — the 


CLOTHING  79 

body  clothing  proper — consists  usually  of  three 
garments,  which  vary  in  pattern  with  individual 
ideas  and  tastes. 

The  socks  are  made  of  silk  thread  or  soft  worsted 
yarn  fashioned  by  needles  into  the  shape  of  shoes, 
and  of  such  a  size  as  to  fit  the  foot  loosely,  while 
covering  the  leg  two  inches  or  more  above  the  ankle. 
They  are  held  in  position  by  a  loosely  tied  tape  or  a 
narrowed  band  of  stitches — the  mechanism  of  which 
every  knitter  will  understand — near  the  top. 
Stockings  are  unnecessary,  and  are  rarely  used 
before  the  clothes  are  shortened. 

The  napkin  or  diaper  may  be  made  either  of 
linen  or  muslin,  the  former  material  being  preferred, 
as  it  is  less  heating  and  less  liable  to  cause  chafing 
of  the  skin  when  wet.  At  first  the  diaper  should 
be  half-a-yard  wide  and  one  yard  long;  later,  as  age 
advances,  larger  sizes  will  be  required.  When  used 
it  is  folded  into  a  square  and  then  into  a  triangle, 
and  must  be  carefully  adjusted  to  the  infant's 
person  so  that  it  may  not  cause  pain  by  undue 
pressure  upon  the  back  or  abdomen. 

A  soiled  napkin  can  never  be  safely  used  a  second 
time,  even  though  the  soiling  medium  be  simply 
urine  and  the  subsequent  drying  be  thorough.  In 
consequence,  an  abundant  supply  is  essential.  The 
least  dampness  renders  its  use  dangerous,  and 
while  insisting  upon  the  washing  of  all  soiled  nap- 


80  HYGIENE    OF   THE   NURSERY 

kins,  it  is  equally  important  that  they  be  aired 
for  at  least  twelve  hours  before  being  used  again, 
that  they  may  be  surely  dry.  One  must  be  most 
careful,  too,  to  insist  upon  the  laundress  washing 
the  napkins  in  hot  suds  made  with  a  pure  soap, 
and  boiling  for  twenty  minutes.  No  soda  is  to  be 
used  in  washing,  and  no  starch  or  bluing  in  ironing 
as  the  constant  contact  of  diapers  impregnated  with 
irritating  substances  is  sure  to  produce  troublesome 
excoriation  of  the  buttocks  and  neighboring  deli- 
cate skin. 

The  band  or  binder  may  be  of  fine,  soft  flannel  or 
of  knitted  wool.  In  either  case  it  should  extend 
from  the  brim  of  the  pelvis  or  hip  bones  to  the  lower 
ribs.  The  flannel  band  should  be  five  inches 
wide  and  twenty  inches  long,  or  long  enough  to  go 
a  little  more  than  around  the  abdomen;  it  should 
be  cut  on  the  bias  to  secure  elasticity,  should  be 
unhemmed,  and  must  be  fixed  in  position  by 
basting,  not  by  safety-pins.  This  band  is  to  be 
preferred  during  the  first  three  weeks  of  life,  for 
the  purpose  of  holding  the  dressing  of  the  cord  in 
place,  and  to  protect  the  navel  before  it  is  perfectly 
healed.  After  the  cord  has  fallen  off  and  the  navel 
is  quite  normal,  a  binder  serves  merely  to  prevent 
abdominal  chilling,  and  it  is  much  better  to  dis- 
card the  flannel  band  and  substitute  a  knitted 
binder;  this  should  be  worn  until  the  eighteenth  or 


CLOTHING  8l 

twentieth  month,  and  sometimes,  if  the  child  be 
subject  to  intestinal  indigestion,  until  the  fourth 
year  or  even  longer.  "Knit  Abdominal  Bands" 
can  be  purchased  in  the  shops  or  any  woman  who 
is  apt  with  her  knitting-needles  can  make  one,  and 
the  product  has  the  advantages  of  being  readily 
applied  and  of  keeping  its  position  without  the  aid 
of  either  strings  or  pins.* 

Several  bands  are  required  to  be  on  hand  at  the 
same  time  for  the  sake  of  proper  cleanliness,  and, 
as  they  should  be  worn  well  into  the  second  year, 
it  is  necessary  to  replace  them,  set  by  set,  as  the 
growth  of  the  child  demands. 

The  body  clothing  is  usually  composed  of  three 
separate  pieces:  a  shirt,  a  petticoat  and  an  outside 
dress  or  "slip."  The  shirt  should  be  long  enough 
to  extend  from  the  neck  to  the  lowest  part  of  the 
trunk  and  have  sleeves  reaching  to  the  wrists.  It 
may  be  made  of  merino  or  of  soft  worsted  yarn. 
In  either  case  it  should  fit  comfortably,  be  open  from 
top  to  bottom  in  front,  and  be  fastened  by  buttons, 

*  Formula  for  Crochetted  Baby-band. — Single  zephyr  in  ridge 
stitch,  that  is,  half  stitch,  in  which,  going  back  and  forth,  only  the 
back  half  of  the  stitches  in  the  lower  row  are  picked  up.  Begin 
on  a  chain  of  fifty  and  crochet  forty-eight  ridges,  hence  ninety-six 
rows.  Join  by  a  row  of  tight  stitches  or  by  sewing.  Finish  off  at 
bottom  by  a  row  of  plain  stitches  and  at  top  by  a  picot-edging  (five 
chains  and  a  tight  stitch  back  into  the  first). — "Babyhood,"  Vol. 
in,  p.  33- 
6 


82  HYGIENE   OF   THE   NURSERY 

with  a  tape  at  the  neck.  The  petticoat  must  be 
long  enough  to  extend  from  the  waist  to  six  or 
eight  inches  below  the  feet.  The  proper  material 
for  the  skirt  is  light,  white  flannel.  This  is 
gathered  at  the  top  into  a  muslin  band,  which  must 
be  deep  enough  to  reach  from  the  hips  to  the 
arm  pits,  and  wide  enough  to  lap  over  considerably 
at  the  back;  it  is  fastened  by  basting  or  very  care- 
fully adjusted  small  safety-pins.  The  overwidth  is 
to  allow  for  increase  in  size. 

An  equally  good  waist  can  be  made  with  arm- 
holes  and  buttoned  in  the  back. 

The  dress  or  slip  is  made  of  fine  cambric,  cut  in 
one  piece,  opening  well  at  the  back  that  it  may  be 
readily  slipped  on  and  off. 

Another,  and  I  think  a  preferable  outfit,  consists, 
also,  of  three  garments.  The  first  or  under  gar- 
ment, made  of  soft,  white  flannel,  is  long  enough  to 
extend  from  the  neck  to  ten  inches  below  the  feet 
— about  twenty-five  inches  in  total  measurement — 
with  wide  arm-holes.  All  the  seams  must  be 
smooth,  and  the  hem  at  the  neck  turned  outward. 
The  next  garment,  cut  in  the  same  way,  but  one- 
half  inch  larger,  and  five  inches  longer,  is  made  of 
muslin.  The  slip  is  also  cut  Princess,  has  long 
sleeves,  a  longer  skirt  than  either  of  the  other  gar- 
ments, and  all  are  fastened  behind  by  small  buttons. 

When  dressing  the  infant  these  three  coverings 


CLOTHING  83 

are  put  together,  sleeve  fitting  to  sleeve,  and  the 
whole  drawn  over  the  little  one's  feet,  then  but- 
toned behind,  and  the  process  is  complete. 

The  advantages  of  the  last  method  of  dressing 
are — 

1.  Perfect  freedom  to  the  organs  contained  with- 
in the  chest,  abdomen  and  pelvis. 

2.  Suspension  of  the  clothing  from  the  shoulders. 

3.  Saving  of  time  to  the  mother  and  fatigue  to 
the  infant  in  the  process  of  dressing. 

4.  A  uniform  covering  of  the  whole  body. 

So  much  for  the  day  clothing.  At  night  the 
dress  should  consist  of  the  flannel  and  the  outer 
garment. 

In  the  foregoing,  my  intention  has  been  to  lay 
special  stress  upon  the  advantage  of  holding  the 
garments  in  place  by  tape  or  buttons  rather  than  by 
pins,  and  it  should  be  noticed  that  a  baby  may  be 
completely  dressed  with  but  one  pin  in  its  clothing, 
namely,  that  fastening  the  napkin.  This,  which  is 
allowed  only  for  the  sake  of  convenience,  must  be 
a  safety-pin,  the  ordinary  pointed  pin  being  an 
abomination  in  the  nursery. 

It  is  hardly  necessary  to  say  that,  for  the  sake 
of  cleanliness,  an  abundant  supply  of  body  clothing 
should  be  at  hand;  a  mother,  particularly,  must 
recognize  that  "  cleanliness  is  next  to  godliness," 
and  provide  accordingly.  Let  her  remember,  too, 


84  HYGIENE   OF   THE   NURSERY 

that  fresh  clothing  must  be  thoroughly  aired  or 
dried  before  it  is  put  upon  the  infant. 

Sometimes,  to  keep  the  body  clothes  dry,  a  piece 
of  thin  rubber  cloth  is  placed  over  the  napkin;  this 
does  nothing  but  harm,  for  it  overheats  the  parts, 
and  when  the  diaper  is  wet  with  urine,  makes  a 
poultice  of  it,  and  thus  macerates  the  skin  and 
causes  irritating  and  painful  excoriation. 

At  the  age  of  six  months  in  summer  and  of  eight 
months  in  winter,  provided,  in  both  cases,  the  health 
be  good,  the  clothing  may  be  shortened.  This 
change  introduces  several  important  questions, 
namely,  the  covering  of  the  legs  and  knees,  and  the 
selection  of  shoes  and  stockings. 

The  shortening  process  makes  no  change  in  the 
body  clothing  except  that  the  skirts  end  a  short  dis- 
tance below  the  knees,  at  about  the  point  to  which 
an  ordinary  shoe  top  comes;  this,  of  course,  prac- 
tically leaves  the  legs,  from  the  top  of  a  short  stock- 
ing to  the  lower  edge  of  the  napkin,  exposed.  As 
already  hinted,  it  is  necessary  for  the  health  of  the 
infant  to  keep  this  comparatively  large  surface  pro- 
tected, except,  perhaps,  during  a  few  extremely 
hot  days  in  midsummer.  There  are  two  ways  of 
accomplishing  this :  either  by  drawers  or  by  stockings 
long  enough  to  extend  from  the  feet  to  the  nap- 
kin, to  which  they  may  be  attached  by  safety- 
pins  or  ordinary  fasteners.  The  best  drawers  are 


CLOTHING  85 

those  made  in  two  pieces,  one  for  each  leg,   as 
shown  in  Fig.  12. 

These,  as  furnished  in  the  stores,  are  made  of 
merino,  but  any  clever  woman  should  be  able  to 
cut  them  out  of  Canton  flannel  and  make  them  at 
home.  They  must  fit  the  legs  moderately  closely, 
and  have  a  buttonhole  at  the  top,  so  that  when 


FIG.  12. — DRAWERS. 

passed  over  the  napkin  they  may  be  buttoned  to 
the  waist  of  the  skirt  on  its  inner  side,  and  so  be 
held  up.  These  drawers  are  not  readily  soiled  as 
they  cover  the  legs  only,  and  the  napkin  comes  be- 
tween. They  must,  of  course,  be  made  of  material 
to  suit  the  season — heavy  in  winter,  light  in  summer. 
When  stockings  alone  are  used  they  must  be 
long  enough  to  come  well  above  the  knees,  and 
should  be  held  in  position  by  " supporters"  instead 


86  HYGIENE   OF   THE   NURSERY 

of  garters,  since  the  latter,  being  necessarily  tight, 
bind  the  limbs,  and  often,  by  interfering  with  free 
circulation,  cause  cold  feet.  The  supporter  must 
be  adjusted  to  make  only  the  required  amount  of 
traction,  and  this  always  in  a  direction  parallel  with 
the  axis  of  the  body.  The  stocking  foot  ought  to 
fit  easily,  but  without  wrinkling,  and  at  the  same 
time  have  a  roomy  and  rounded  rather  than  a  con- 
ical-shaped toe.  For  although  the  silk,  woolen,  or 
cotton  material  of  which  the  stocking  is  composed 
may  be  yielding,  it  is  elastic,  and  consequently 
capable  of  exerting  a  certain  amount  of  pressure 
upon  the  foot;  and  there  is  little  doubt  that  the  per- 
sistent compression  made  by  a  short,  sharply  conical 
point  cramps  the  toes,  crowds  them  together,  and 
sometimes  even  forces  them  to  overlap  one  another. 

Colored  stockings  are  often  preferred  to  white, 
but  they  are  only  permissible  provided  the  coloring 
matter  be  well  fixed  in  the  texture  and  not  of  such 
a  nature  as  to  cause  irritation  of  the  skin.  Every 
stocking  should  be  turned  inside  out,  carefully 
examined,  and  all  knots  and  ends  removed,  the 
smallest  of  which  hurt  the  tender  little  feet,  and 
stockings  having  seams  to  be  pressed  by  the  shoe 
into  the  back,  soles  or  sides  of  the  foot  must  be 
avoided.  Were  these  details  oftener  looked  to, 
many  an  unexplained  tear  would  be  avoided. 

As  with  the  drawers,  so  with  the  hose;  several 


CLOTHING  87 

weights  should  be  provided  to  correspond  with  the 
varying  demands  of  .the  season  for  greater  or  less 
warmth,  and  in  both  cases  a  sufficient  supply  must 
be  kept  to  allow  of  frequent  changing. 

The  shoes  are  prominent  items  of  the  clothing; 
their  shape,  size  and  manner  of  fastening,  and  the 
make-up  of  the  soles  being  the  important  matters 
for  consideration. 

An  infant's  feet  are  plumper  than  those  of  the 
adult,  and  all  the  tissues,  but  especially  the  bones, 
are  softer.  They  may  be  readily  deformed  by 
protracted  pressure  from  badly  constructed  shoes, 
despite  the  assertions  of  unhandy  shoemakers,  who 
say  that  the  feet  are  shapeless  masses  of  fat,  for 
which  any  leathern  bag  having  the  semblance  of  a 
shoe  will  serve  as  a  covering. 

Throwing  out  the  element  of  fleshiness,  the 
characteristics  of  the  perfectly  formed  baby  and 
adult  foot  do  not  materially  differ.  In  the  first 
place,  the  inner  and  outer  margins  are  very  different 
in  contour;  second,  the  heel  and  middle  third  of 
the  foot  is  firm  and  presents  little  mobility  in  its 
component  bones,  whereas  the  anterior  third,  in- 
cluding the  toes,  is  very  mobile.  The  toes  again 
bear  much  the  same  relation  to  the  rest  of  the  foot 
as  the  fingers  to  the  hand.  This  is  particularly 
noticeable  in  the  great  toe,  which,  instead  of  inclin- 
ing toward  a  line  passing  along  the  center  of  the 


88  HYGIENE   OF   THE   NURSERY 

foot,  points  away  from  it,  in  the  same  manner  as  the 
thumb  from  the  hand,  although,  of  course,  to  a  far 
less  degree.  An  inclination  of  the  great  toe  toward 
the  mid-line  of  the  foot  is  undoubtedly  often  seen  in 
adults,  but  in  them  it  is  a  deformity  resulting  from 
badly-made  shoes,  and  one  that  gives  a  conical 
contour  to  the  toes,  cripples  the  movements  of  the 
great  toe,  and  greatly  interferes  with  the  ease  of 
walking,  just  as  a  contraction  and  permanent  draw- 
ing of  the  thumb  toward  the  palm  of  the  hand 
would  materially  lessen  the  usefulness  of  that 
member. 

The  normal  position  of  the  toes  just  described 
will  be  readily  understood  from  the  tracing  of  the 
sole  of  the  foot  as  shown  in  Fig.  13. 

The  most  striking  features  of  this  diagram  are, 
the  expanded  position  of  the  toes;  the  width  of  the 
anterior  part  of  the  foot  compared  with  the  heel, 
and  the  straight  outer  and  curved  inner  margins  of 
the  foot.  The  line  AB  represents  the  axis  of 
walking,  which,  while  nearly  parallel  to  EF,  the 
inner  edge  of  the  foot,  forms  quite  an  angle  with 
CD,  the  center  line. 

In  the  normal  foot  the  great  toe  is  directly  in  the 
axis  of  walking,  a  position  in  which,  of  course,  it 
is  of  much  greater  service  than  if  it  were  inclined 
inward  toward  the  line  CD. 

Now,  if  a  line  be  drawn  closely  around  the  mar- 


CLOTHING  89 

gin  of  the  imprint,  it  will  give  the  exact  shape  of 
a  perfect  shoe  sole  for  the  right  foot;  or  taking  the 
imprint  of  both  feet,  we  get  the  outlines  shown 
in  Fig.  14. 

B  D 

F\ 


PIG.  13. — TRACING  OF  NORMAL  FOOT. 

On  first  sight,  one  would  suppose  that  a  shoe 
with  a  sole  so  shaped  would  look  very  awkward, 
but  when  made  by  a  skilful  shoemaker,  it  differs 
very  little  in  appearance  from  those  ordinarily  sold 
in  the  shop,  with  the  exception  that  it  is  broader  at 
the  toes. 


QO  HYGIENE   OF   THE   NURSERY 

Another  important  fact  is  clearly  demonstrated 
by  Fig.  14,  namely,  the  absolute  necessity  of  having 
the  shoes  made  "right"  and  "left,"  and  the  fallacy 
of  supposing  that  one  or  the  other  shoe  may  be  used 
on  either  foot  indiscriminately. 

Besides    having    a    correct    shape,    the    shoes 


Left  Foot.  Right  Foot. 

FIG.  14. — SHAPE  OF  PROPER  SHOE  SOLES. 


should  be  long  enough  not  to  cramp  the  toes  and 
bend  them  down  and  backward  upon  themselves. 
At  the  same  time  it  is  a  mistake  to  have  them  too 
long,  allowing  the  foot  to  slide  back  and  forth,  as 
this  leads  to  the  formation  of  either  blisters  or 
corns.  Let  the  shoe  fit  snugly  about  the  heel  and 
instep,  and  easily  at  the  toes,  and  all  is  well.  I  say 


CLOTHING  91 

easily  at  the  toes,  because  many  an  otherwise  good 
shoe  is  ruined  by  having  the  uppers  at  the  points 
too  scanty,  so  that  the. toes  are  forced  against  the 
sole  and  subjected  to  painful  pressure. 

The  best  method  of  fastening  is  by  a  lace,  since 
this  admits  of  making  one  part  of  the  upper  tight 
and  another  part  loose,  according  to  circumstances. 

Elastic  fastenings,  as  in  so-called  congress  shoes, 
are  not  good  for  children;  and  when  buttons  are 
used,  the  nurse  must  not  necessarily  leave  them  in 
the  position  fixed  by  the  shoemaker,  but  move  one 
or  more  as  the  size  of  the  ankle  demands. 

The  thickness  of  the  soles  depends  upon  the  age 
of  the  child.  Before  walking  is  attempted,  they 
may  be  thin,  flexible,  and  of  uniform  thickness  from 
heel  to  toe;  afterward  they  should  be  made  heavier 
and  more  resisting,  in  order  to  protect  the  tender 
feet,  and  should  be  decidedly  thicker  at  the  heel, 
that  this  part  of  the  foot  may  be  elevated.  A  clear- 
cut  heel,  however,  as  in  boots  adapted  for  adults, 
is  not  to  be  recommended  in  children's  shoes  before 
the  age  of  six  or  eight  years. 

Sometimes  a  careful  mother  may  notice  that,  for 
a  short  time  after  stockings  and  shoes  are  put  upon 
her  baby,  the  feet  are  cooler  than  before.  Undue 
pressure  about  the  ankle,  with  consequent  inter- 
ference with  the  blood  circulation  in  the  feet,  is  the 
cause  of  this,  and  the  remedy  is  to  remove  occa- 


Q2  HYGIENE    OF   THE   NURSERY 

sionally  the  coverings,  chafe  the  feet  into  warmth, 
and  see  that  the  shoe-top  is  not  so  tightly  laced  or 
buttoned  as  to  constrict  the.  ankle. 

So  far,  all  that  has  been  said  of  the  clothing 
after  shortening  refers  to  the  day  and  house  gar- 
ments. It  remains  now  to  consider  the  night  dress 
and  the  extra  wraps  to  be  worn  out  of  doors. 

At  bedtime,  all  the  clothing  worn  during  the  day 
being  removed,  the  baby  is  washed,  and  after  the 
application  of  a  fresh  napkin  and  binder,  is  ready 
for  the  night  dress.  This  consists  of  a  shirt  and 
a  special  gown.  The  shirt  should  be  of  flannel 
or  merino,  a  light  gauze  in  summer  and  a  heavier 
material  in  winter;  its  pattern  may  be  the  same  as 
that  worn  by  day,  though  its  texture  ought  to  be  a 
trifle  lighter.  The  best  pattern  of  a  winter  night- 
gown is  a  long,  plain  slip,  with  a  drawing  string  at  the 
bottom,  to  prevent  exposure  of  the  feet  and  limbs, 
should  the  child  kick  off  the  bed  covering  during 
sleep.  It  ought  to  be  made  of  flannel,  or  the  more 
easily  washed  Canton  flannel.  In  summer,  a  loose 
muslin  slip  of  the  same  design,  but  without  the 
drawing  string,  may  be  worn.  There  is  even  more 
temptation  by  night  than  by  day  to  use  a  rubber 
cloth  over  the  napkin,  to  protect  the  body  and  bed 
clothing,  but  never  do  this. 

It  is  a  good  plan  to  provide  the  child  with  a  flannel 
garment  corresponding  to  the  dressing  gown  of  the 


CLOTHING  93 

adult,  and  with  a  pair  of  bedroom  shoes.  The 
latter  are  composed  of  soft  leather  or  felt  soles  and 
knitted  uppers,  and  are  fastened  around  the  ankle 
by  a  soft  elastic.  Both  of  these  will  be  found  use- 
ful in  the  many  occasions  when  the  child  has  to  be 
taken  up  at  night. 

When  dressing  a  child  for  exercise  in  the  open 
air  in  cold  weather,  do  not  put  on  the  extra  outer 
clothing  until  immediately  before  leaving  the  house, 
and  remove  it  directly  on  returning.  A  long  cloak, 
with  or  without  capes,  according  to  the  degree  of 
cold,  and  a  pair  of  long,  warm  leggings,  constitute 
the  extra  covering  for  the  body.  Protect  the  head, 
in  winter,  by  a  close-fitting  thick  cap;  the  hands, 
by  worsted  gloves  or  mittens. 

In  summer  the  child  may  go  out  of  doors  in  the 
same  dress  worn  in  the  house,  the  head  being  pro- 
tected from  the  direct  rays  of  the  sun  by  a  broad- 
brimmed,  light  straw  hat. 

Every  mother  must  decide  for  herself  when  her 
child  is  to  doff  the  costume  of  babyhood  and  assume 
that  of  the  boy  or  girl.  There  are  two  points  that 
must  always  be  considered,  however,  namely,  the 
time  of  dispensing  with  the  napkin  and  with  the 
abdominal  belt.  Abandon  the  napkin,  and  sub- 
stitute ordinary  drawers,  as  soon  as  the  child  can 
be  trusted  to  make  known  the  calls  of  nature — a 
period  that  varies  considerably  with  the  care  and 


94  HYGIENE    OF   THE   NURSERY 

skill  in  training.  The  binder,  as  already  indicated, 
should  always  be  worn  until  about  the  end  of  the 
second  year. 

In  clothing  the  boy  or  girl,  be  particular  to  se- 
cure warmth,  freedom  of  movement  and  cleanliness. 
The  first  is  accomplished  by  enveloping  the  whole 
body — no  matter  what  the  season — in  woolen 
underclothing.  This  means  high-neck  and  long- 
sleeve  flannel  shirts  and  flannel  drawers  extending 
down  to  the  ankles.  It  is  hardly  necessary  to  men- 
tion that  the  thickness  of  these  garments  must  vary 
with  the  seasons,  but  it  is  quite  worth  while  insisting 
upon  woolen  undergarments,  except  during  the 
very  excessively  hot  days  of  midsummer.  This 
provision  being  made,  and  the  shape  of  the  shoes 
and  stockings*  looked  into,  it  matters  little  what 
may  be  the  fancy  of  the  mother  in  regard  to  outer 
clothing.  While  securing  warmth,  we  must  not  go 
to  the  other  extreme  and  burden  the  child  with 
underwear  so  heavy  that  constant  perspiration  is 
produced.  The  risk  of  this  is  great  during  the  winter 
in  the,  so  often,  over-heated  city  house,  and  it  is 
much  better  to  select  underclothing  of  just  sufficient 

*  It  is  impossible  for  either  a  stocking  or  shoe  to  fit  accurately 
unless  the  toe-nails  be  kept  in  good  order.  In  cutting  the  toe-nails 
there  is,  as  in  every  other  affair  of  life,  a  right  and  a  wrong  way. 
Cut  the  nail  directly  across,  without  rounding  the  corners.  Should 
the  latter  be  done,  the  nail  is  apt  to  grow  into  the  flesh  and  give 
suffering  to  the  child  and  work  to  the  surgeon. 


CLOTHING  95 

weight  to  keep  the  skin  warm  without  over-activity, 
depending  upon  thick  overcoats  and  wraps  to 
conserve  the  body  temperature  when  out-of-doors. 
Again  it  must  be  remembered  that  there  are  a  few 
children  who  cannot  comfortably  wear  woolen  un- 
derclothing on  account  of  a  very  sensitive  or  a  very 
active  skin.  These  either  suffer  from  irritation 
rashes  or,  having  a  constantly  moist  surface,  are 
readily  chilled  in  passing  from  warm  rooms  to  a 
cool  outdoor  air,  and  do  much  better  when  clothed 
with  some  other  material,  as  linen-mesh  or  cotton 
stockinet. 

Freedom  of  movement  refers  not  only  to  the 
limbs,  but  to  the  chest  and  abdomen,  which  should 
never  be  constricted,  lest  the  important  organs  they 
contain  be  crippled  in  their  action.  Loose-fitting 
clothes  accomplish  this  object;  but  it  is  to  be  under- 
stood that  looseness  or  ease  in  fit  does  not  necessarily 
imply  that  the  dress  must  be  awkward,  ill-fitting, 
and  a  source  of  mortification  to  the  wearer.  On 
the  contrary,  clothes  must  be  easy  and  yet  well  cut 
and  stylish. 

To  be  clean,  the  child  must  have  a  plentiful  sup- 
ply of  clothing,  so  that  changes  may  be  made  as 
frequently  as  required.  Clean,  cheap  clothes  look 
much  better  than  soiled  finery. 

The  night  dress  or  a  child  five  or  six  years  old 
consists,  during  winter,  of  a  light,  high-neck  and 


96  HYGIENE   OF   THE  NURSERY 

long-sleeve  merino  shirt  and  night  drawers  of  Can- 
ton flannel;  in  summer,  of  a  gauze  undershirt,  with 
short  sleeves  and  muslin  night  drawers. 

Cold  weather  calls  for  a  warm  overcoat,  hat, 
mittens,  and  leggings,  or  rubber  boots  in  wet  or 
snowy  weather,  when  the  child  leaves  the  warmth 
of  the  house.  Should  the  cold  be  so  great  as  to 
necessitate  ear  tabs  and  a  neck  wrap  for  protection, 
a  child  under  six  years  is  better  off  in  the  nursery. 

As  to  rainproof  clothing — and  our  climate  calls 
often  for  both  rubber  boots  and  a  long  mackintosh — 
it  must  be  remembered  that  such  coverings,  while 
impervious  to  moisture  from  without,  are  no  more 
pervious  to  body  moisture  or,  in  other  words,  to 
perspiration,  which  secretion  they  encourage  by 
their  warmth.  Of  course,  when  perspiration  is  re- 
tained, the  underclothing  becomes  moist,  and  there 
is  a  great  risk  of  surface  chilling  and  consequent 
catarrh.  Therefore,  it  is  a  good  plan,  when  water- 
proof garments  have  been  worn  for  any  length  of 
time,  to  take  off  the  underclothing  as  soon  as  shel- 
ter is  reached,  to  rub  the  surface  into  a  glow  with  a 
coarse  towel  and  then  redress  the  child. 

Before  concluding  this  chapter,  let  me  advise 
that  the  change  from  winter  to  spring  or  summer 
clothing  be  not  made  at  any  fixed  date,  under  the 
supposition  that  it  is  the  time  to  change,  and  the 
weather  should  be  warm,  whether  it  is  or  not.  In 


CLOTHING  97 

our  Eastern  climate  it  is  unusual  to  have  settled, 
warm  weather  until  June.  May  has  a  certain  num- 
ber of  warm  days,  but  they  are  quickly  followed 
by  cooler  ones.  Consequently  the  safe  plan  is  to 
keep  on  the  winter  flannels  until  hot  weather 
surely  sets  in,  changing,  in  the  meanwhile,  the 
outer  clothing  to  suit  each  day. 


CHAPTER  V. 

EXERCISE   AND  AMUSEMENTS. 

Healthful  exercise,  especially  when  taken  in  the 
open  air  and  sunshine,  invigorates  the  nerves;  se- 
cures an  active  performance  of  such  vital  functions 
as  circulation,  respiration  and  digestion;  maintains 
a  hearty  appetite  and  regular  movement  of  the 
bowels,  and  develops  the  muscles. 

Symmetry  of  development  is  essential,  and  on 
this  account  any  exercise  or  play  that  brings  but  one 
or  a  few  sets  of  muscles  into  action  must  be  dis- 
countenanced. The  muscles  control  the  bones,  and 
should  one  set  be  comparatively  feeble,  the  bones 
they  move  are  dragged  out  of  form  by  stronger 
opposing  sets.  Probably  the  most  important  groups 
of  muscles  to  render  strong  are  those  of  the  back 
which  hold  the  spine  in  proper  position.  When 
these  are  weak — the  greatest  weight  of  the  trunk 
being  toward  the  front — the  backbone  has  a  ten- 
dency to  be  drawn  forward  in  such  a  way  that  the 
movements  of  the  chest  are  crippled,  and  respira- 
tion so  interfered  with  that  the  blood  is  imperfectly 
aerated,  nutrition  fails,  and  the  child  becomes  a 
weak,  puny  invalid. 

98 


EXERCISE  AND   AMUSEMENTS  99 

M 

Curvature  of  the  spine — the  deformity  here  re- 
ferred to — may  also  interfere  with  other  functions; 
for  instance,  digestion,  elimination  of  urine  and 
the  motion  of  the  legs.  Bone  deformities  are  more 
apt  to  occur  in  children  than  in  adults,  because,  in 
the  former,  the  bones,  not  being  thoroughly  set 
and  hardened,  are  more  readily  influenced  by  irregu- 
lar muscular  action. 

Marking,  then,  the  necessity  for  equal  muscular 
development,  the  subject  of  exercise  may  be  taken 
up  in  detail. 

The  first  exercise  the  infant  gets  will  be  in  the 
nurse's  arms.  Shortly  (three  or  four  days)  after 
birth  the  baby  may  be  taken  from  its  crib  two  or 
three  times  a  day,  and,  being  placed  upon  its  back 
on  a  pillow,  carried  about  the  room  for  ten  or  fifteen 
minutes.  In  the  second  month,  longer  walks  may 
be  taken,  the  pillow  being  discarded  and  the  infant 
carried  in  a  reclining  position  in  the  arms,  with  the 
head  and  body  thoroughly  supported. 

By  the  fourth  month  the  child  will  have  gained 
sufficient  muscular  strength  to  maintain  a  sitting 
posture  for  a  short  time,  provided  the  head  and 
shoulders  be  supported  by  the  nurse's  hand,  and  in 
this  way  it  may  be  carried  about  on  the  right  or 
left  arm — and  it  is  most  important  not  to  use  one 
arm  constantly — for  its  daily  training. 

At  the  end  of  the  eighth  month  a  healthy  child 


100  HYGIENE    OF    THE   NURSERY 

ceases  to  require  support  to  the  head  and  back 
when  carried,  but  not  before. 

After  the  infant  ceases  to  be  merely  a  sleeping 
and  eating  animal,  and  begins  to  show  signs  of 
humanity — at  about  the  fourth  month,  for  ex- 
ample— he  should  be  laid  upon  a  soft  mattress  or 
sofa  several  times  each  day  and  allowed  to  do  as  he 
pleases. 

Under  these  circumstances  he  rolls  about  and 
kicks  his  legs,  clasps  and  unclasps  his  fists,  moves 
his  arms,  and  crows  or  cries.  All  these  movements 
serve  a  purpose;  the  legs  gain  strength  for  future 
walking;  the  hands,  for  grasping;  the  arms,  for 
carrying,  and  the  vocal  organs,  for  speaking. 

A  certain  class  of  nurses  seems  unable  to  com- 
prehend that  a  baby  is  a  tender  creature,  tender 
not  only  in  age,  but  in  the  texture  of  all  its  tissues. 
They  support  a  young  infant  upright  upon  their 
knees  and  violently  jolt  it  up  and  down,  under  the 
supposition  that  it  gives  pleasure,  and  should  the 
child  cry  they  add  to  its  torment  by  a  peculiar 
"song."  Gentle  movement  is  as  pleasant  to  the 
child  as  riding  in  an  easily  running  carriage  on  a 
smooth  road  is  to  an  adult;  knee-jolting  is  as  un- 
pleasant and  harmful  as  a  journey  over  the  worst 
corduroy  road.  The  so-called  singing  must  cause 
only  pain. 

The  question  of  "airing"  or  subjecting  the  infant 


EXERCISE   AND  AMUSEMENTS  IOI 

to  out-door  air,  arises  soon  after  birth.  Airing 
in-doors  consists  in  taking  the  child  fully  dressed  as 
if  going  out,  into  a  room  having  a  southerly  ex- 
posure, with  wide  open  windows  but  closed  doors 
to  prevent  a  strong  current  of  air.  It  may  be  begun, 
even  in  winter,  at  the  age  of  one  month,  the  first 
airing  lasting  for  fifteen  minutes  only,  and  the  time 
slowly  increased,  by  ten  minutes  daily,  until  three 
or  four  hours  are  occupied.  This  procedure  is  safe 
and  beneficial  in  practically  all  sorts  of  weather, 
and  with  delicate  children  and  those  recovering  from 
an  illness,  should  be  the  only  form  of  airing  allowed 
during  the  winter  months. 

Airing  out-of-doors  should  be  commenced,  under 
normal  conditions,  as  soon  as  the  child  has  arrived 
at  the  proper  age,  and  providing  always  that  the 
weather  be  favorable.  The  fifth  month  is  the  proper 
age  for  children  born  in  the  early  fall  and  winter, 
and  the  second  month,  for  those  born  in  summer. 
In  cool  weather  they  should  be  taken  out  in  a 
baby  carriage  or  in  the  nurse's  arms,  for  an  hour 
in  the  morning  and  half  an  hour  in  the  afternoon, 
while  the  sun  is  shining.  In  summer,  they  may  pass 
the  greater  part  of  their  waking  hours  in  the  open 
air.  In  damp  and  rainy  weather,  when  there  is  a 
strong  east  or  north  wind  blowing,  or  when  the 
mercury  stands  below  20°  F.,  young  children  are 
better  off  in  the  nursery.  The  hardening  process,  in 


102  HYGIENE   OF   THE   NURSERY 

our  climate,  so  far  from  being  successful,  usually 
results  in  an  attack  of  bronchitis  or  something 
worse,  which  may  house  the  child  for  a  long  time, 
and  thus  deprive  him  of  the  advantage  of  sub- 
sequent favorable  weather. 

How  shall  the  baby  be  taken  out?  The  answer 
to  this  question  involves  the  consideration  of  two 
points,  namely,  the  clothing  and  the  means  of  con- 
veyance. The  former  has  already  been  refer r  ed  to. 

As  to  the  method  of  conveyance,  the  arm  is  to 
be  preferred  for  very  young  infants,  especially  in 
cold  weather,  because  they  are  apt  to  be  uncomfort- 
able in  a  baby  carriage,  and  because  as  they  must, 
when  carried,  be  held  close  to  the  nurse's  body, 
they  are  kept  warm  by  the  heat  given  off  from  the 
bearer. 

After  the  fourth  month  a  carriage  may  be  used. 
Now  there  are  good  and  bad  baby  carriages,  as  well 
as  a  right  and  a  wrong  way  of  trundling  them;  and 
here  again  the  mother  must  not  forget  that  the  baby 
is  a  tender  creature  and  very  easily  hurt. 

The  best  kind  of  carriage  is  none  too  good  for 
the  load  it  is  destined  to  carry.  It  should  run 
smoothly,  without  jolt  or  jar;  its  wheels  should  be 
provided  with  rubber  tires  and  kept  from  creaking 
by  the  frequent  application  of  some  mineral  oil, 
as  sewing-machine  oil;  the  bed  must  be  soft  and 
comfortable,  lateral  support  being  given  to  the  body 


EXERCISE  AND  AMUSEMENTS  103 

by  two  long,  narrow  and  soft  pillows;  the  infant 
must  never  be  strapped  down,  the  feet  must  be  kept 
properly  covered  and  warm,  and  the  parasol 
always  must  be  at  hand,  and  so  arranged  as  to 
protect  from  wind,  and  shade  the  tender  eyes  from 
bright  sunlight. 

While  the  carriage  is  a  convenience  to  the  nurse, 
it  is  never  to  be  regarded  as  a  place  of  security  for 
the  child,  to  be  left  on  the  sidewalk  or  in  windy 
places  while  the  wheeler  exchanges  gossip  with 
fellow-nurses  or  enters  a  house  to  visit  friends. 
However  good  its  springs  may  be,  they  are  never 
easy  enough  to  allow  of  rude  jolting  or  of  mount- 
ing a  raised  curbstone  by  mere  dint  of  hammering 
and  muscle  force. 

After  the  age  of  nine  or  ten  months  a  healthy 
child  will  begin  to  creep;  at  the  end  of  a  year  he 
will  make  efforts  to  stand,  and  from  four  to  eight 
months  later  will  be  able  to  walk  by  himself.  Chil- 
dren, however,  present  great  differences  in  this 
respect,  and  a  delay  of  a  few  months  must  not  be 
considered  abnormal.  Second  children  are  usually 
more  active  than  those  born  first,  since  they  imitate 
and  are  encouraged  by  the  example  of  their  elders. 

As  soon  as  efforts  at  creeping  are  made  there 
need  be  no  fear  that  insufficient  exercise  will  be 
taken;  the  care  should  be,  rather,  to  prevent  over- 
fatigue,  as  the  baby,  delighted  by  its  new-found 


IO4  HYGIENE   OF   THE   NURSERY 

powers,  will   be   inclined   to  exert  them   all  day 
long. 

The  question  arises  at  this  stage  whether  or  not 
the  nursery  floor  is  a  permissible  field  for  exercise. 
This  depends  entirely  upon  the  child's  health,  the 
state  of  the  weather  and  the  condition  of  the  nursery. 
Remember  always  that  the  stratum  of  air  next  to  the 
floor  is  much  lower  in  temperature  than  the  middle 
or  upper.  In  some  of  the  biting  days  of  winter  it 
becomes  so  cold  as  to  make  the  feet  and  legs  of  an 
adult  uncomfortable,  and  completely  to  chill  a  child, 
who,  in  creeping,  has  his  whole  body  in  it  for  long 
periods.  Therefore,  should  a  child  be  delicate, 
should  he  have  either  bronchitis  or  catarrh  of  the 
digestive  tract,  should  the  weather  be  very  cold,  or 
should  the  heating  of  the  chamber  be  imperfect,  it 
is  better  to  keep  him  off  the  floor  and  let  him  take 
his  exercises  on  the  nurse's  bed,  which  may  be 
stripped  down  to  the  mattress  for  the  purpose. 
Colds  are  contracted  and  many  more  are  protracted 
by  playing  on  the  floor  in  winter. 

Many  nurses,  and  some  mothers,  have  an  idea 
that  a  child  should  walk  at  a  certain  fixed  age,  and 
when  this  time  arrives,  put  into  practice  various 
plans  for  teaching  the  process.  Beware  of  this,  for 
go-carts,  leading-strings,  baby- jumpers  and  all  con- 
trivances of  this  ilk  have  a  tendency  to  flatten  the 
chest,  distort  the  spine,  or  deform  the  legs.  The 


EXERCISE  AND   AMUSEMENTS  105 

proper  and  only  safe  plan  is  to  let  the  child  teach 
himself  to  walk.  This  he  readily  does,  first  through 
the  act  of  creeping,  in  which  he  exercises  every 
muscle  of  the  body  without  throwing  undue  weight 
upon  the  soft  bones.  When  by  this  exercise  he  has 
sufficiently  strengthened  the  muscles,  he  will  in- 
stinctively seek  to  do  more;  first  in  an  effort  to  get 
upon  the  feet,  in  which,  though  failure  occurs  over 
and  over  again,  he  perseveres  until  successful  in 
standing  with  support,  then  without,  and  finally  ends 
in  walking. 

The  first  acquisition  of  the  power  of  walking 
should  not  be  overtaxed,  and  for  a  month  or  more 
the  carriage  is  the  best  means  of  airing;  but  as  soon 
as  sufficient  strength  is  acquired  for  active  exercise — 
a  somewhat  variable  age — the  child  should  walk  out 
and  pass  as  much  time  as  the  weather  and  nursery 
requirements  permit  in  the  open  air.  Set  walks, 
however,  are  an  abomination  to  -the  child  as  well  as 
to  the  adult.  City-bred  children  suffer  in  this 
respect,  as  they  are  too  frequently  sent  out  merely  to 
walk  a  certain  number  of  blocks,  or  for  a  fixed 
time,  and  it  is  no  wonder  that  they  quickly  tire  of 
such  exercise  and  prefer  their  nurseries  to  the  streets. 
The  only  way  to  avoid  this  is  to  give  an  object  to 
the  outing,  as,  for  example,  a  household  errand  or 
the  purchase  of  a  cheap  toy.  In  the  country,  on 
the  Bother  hand,  children  run  about  and  amuse 


106  HYGIENE    OF   THE   NURSERY 

themselves  according  to  their  own  pleasure,  visit 
the  garden  or  the  farm,  and  involuntarily  take  that 
kind  and  degree  of  exercise  best  calculated  to 
promote  the  growth  and  development  of  their 
bodies. 

Delicate  children  preeminently  require  pure  air 
and  an  outdoor  life,  although  many  of  them  are  too 
feeble  to  take  sufficient  exercise  on  foot.  For  such, 
when  the  parents'  purse  allows,  a  donkey  or  a  pony 
should  be  provided.  Driving  may  give  sufficient 
exercise  at  first;  but  as  soon  as  enough  strength  is 
gained,  riding  is  to  be  preferred,  as  it  keeps  the 
mind  more  healthfully  occupied,  strengthens  the 
muscles,  expands  the  chest  and  produces  a  healthy 
appetite  and  digestion.  Children  who  are "  not 
allowed  sufficient  out-door  life  because  they  take 
cold  easily,  should  live  in  cool  rooms,  wear  less 
heavy  underclothing  to  insure  a  dry  skin,  and  have 
the  body,  particularly  the  chest  and  back,  sponged 
once  daily  with  cool  water — 5o°-6o°  F. — or,  in 
the  case  of  young  infants,  65°-7o°  F. 

In  the  earlier  years  of  life  the  girl  and  boy  play 
together  and  take  nearly  the  same  sort  and  amount 
of  exercise.  As  time  goes  on,  however,  and  the 
girl  approaches  nearer  and  nearer  to  maidenhood, 
she  too  frequently  begins  to  look  upon  her  brother's 
game  of  ball  or  romping  play  as  too  rough,  and 
spends  a  constantly  increasing  time  indoors  acquir- 


EXERCISE  AND  AMUSEMENTS  107 

ing  the  manners  and  the  sedentary  habits  of  her 
elders  of  the  same  sex. 

This  tendency  is  often  encouraged  by  parents, 
who  prefer  polished  manners  to  physical  strength, 
and,  above  all,  dislike  their  daughters  becoming 
"  torn-boys."  One  must  admit  that  polished  man- 
ners are  a  great  attraction;  but  as  a  woman  has 
more  important  duties  than  shining  in  a  drawing- 
room,  they  are  of  little  intrinsic  value  when  uncom- 
bined  with  the  fine  carriage  and  good  figure  which 
belong  to  robust  health. 

In  regard  to  the  carriage  and  figure,  it  is  useless 
to  try  to  assist  their  formation  by  the  aid  of  braces 
and  stiff  corsets.  The  latter  are  especially  to  be  con- 
demned. Unless  most  cautiously  used,  they  induce 
undue  contraction  of  the  lower  part  of  the  chest 
and  displace  the  solid  organs  (liver  especially)  of 
the  abdomen,  interfering  primarily  with  respiration 
and  digestion,  and  secondarily  with  the  general 
processes  of  nutrition.  An  erect  carriage  can  be 
better  secured  by  attention  to  the  general  health; 
suitable  diet;  regulation  of  the  bowels;  cold  bath- 
ing and  sponging,  and  exercise  short  of  fatigue,  not 
of  particular  muscles  only,  but  of  the  whole  frame. 

My  advice,  therefore,  is  to  let  the  girls  join  in  the 
boys'  play.  By  this  plan  the  latter  gain,  because 
they  are  naturally  forced  to  be  more  gentle,  and  the 
former,  because  their  rapidly-developing  frames  get 


I08  HYGIENE   OF   THE   NURSERY 

the  requisite  amount  of  exercise.  It  is  well,  how- 
ever, to  curb  the  ambition  of  the  girls  to  equal  the 
athletic  powers  of  the  boys,  for  their  muscular 
strength  is  less.  Without  letting  the  subjects  know, 
keep  a  strict  lookout  upon  the  general  morals,  for 
it  is  absurd  to  shut  one's  eyes  to  this  risk  in  mingling 
the  sexes  in  later  childhood  and  youth. 

Amusements. — A  child's  life  must  be  devoted  to 
the  cultivation  of  his  mind  and  his  body,  an  undue 
development  of  either  resulting  in  an  incomplete 
manhood  or  womanhood. 

After  writing  the  above  sentence  I  was  called 
from  my  desk  to  the  bedside  of  a  little  sufferer,  and 
on  my  way  met  two  boys,  both  about  nine  years  of 
age,  and  both  patients  of  mine.  The  first  had  a 
spirituelle  face,  and  spoke  to  me  with  a  tip  of  the 
hat  and  the  grace  of  a  little  Chesterfield;  but  his 
features  were  pinched,  so  it  seemed  to  me,  while 
his  face  was  anxious  and  his  legs  were  hardly  thick 
enough  to  carry  his  body.  Nevertheless,  his  arms 
were  full  of  books,  which,  as  I  had  curiosity  enough 
to  examine,  I  found  to  be  a  Greek  grammar,  Csesar, 
and  the  elements  of  algebra.  I  felt  sorry  for  the 
overtaxed  little  brain,  and  he  showed  no  symptoms 
of  joy  at  release  from  school,  for  he  was  on  his  way 
home  to  study  all  his  books,  to  get  the  teacher's 
approval  and  a  high  mark  on  the  morrow.  Scarcely 
a  block  away  I  met  my  next  little  friend;  his  cheeks 


EXERCISE  AND  AMUSEMENTS  1 09 

were  rosy,  his  arms  and  legs  sturdy,  and  his  eyes 
brimful  of  health  and  fun.  The  burden  of  books 
he  bore  was  light,  and  his  teacher  probably  con- 
sidered him  stupid;  but  his  simple  "Hello,  Doctor, 
I  am  off  for  a  game  of  ball  this  afternoon,"  and  his 
jolly  smile  were  more  pleasing  than  all  the  learning 
of  the  first  little  gentleman. 

The  lesson  taught  by  these  two  children  is  very 
plain  to  my  mind,  and  the  question  which  will 
come  out  ahead  in  the  long  run  is  easily  answered ; 
for  health  has  no  handicap  in  the  race  of  life. 

It  is  right,  'of  course,  to  let  the  children  study- 
after  the  sixth  year;  but  the  brain  is  not  to  be  cul- 
tivated at  the  expense  of  the  body.  In  other  words, 
our  boys  and  girls  must  have  plenty  of  play. 

The  subject  of  childish  diversion  is  a  broad  one, 
and  it  is  only  possible  to  outline  it  here.  Let  the 
healthy  child  play  as  much  as  possible  in  the  open 
air,  and  let  him  be  as  active  as  he  pleases;  for  his 
own  sensations  will  tell  him  when  to  stop  and  when 
to  begin  again.  The  only  cautions  are  not  to  over- 
look him  too  much;  to  let  him  make  as  much  noise 
as  he  wishes  out  of  doors  and  in  his  own  kingdom 
—the  nursery;  to  make  him  play  those  games 
which  will  exercise  all  the  muscles  of  the  body 
equally,  and  to  guard  him,  when  heated,  from  drink- 
ing ice-water  or  from  lying  on  the  cold,  damp 
ground,  or  sitting  in  a  draught.  It  must  be  remem- 


110  HYGIENE   OF   THE   NURSERY 

bered,  also,  that  play  is  the  child's  business,  so  that 
during  convalescence  from  a  debilitating  disease  it 
must  be  regulated  according  to  the  strength. 

Before  closing  this  chapter  a  protest  must  be 
entered  against  roller-skates,  as  they  are  dangerous 
to  life  and  limb.  Bicycles  with  wheels  of  equal 
size  are  not  objectionable,  if  the  proper  upright 
position  on  the  seat  be  insisted  upon  and  if  the 
temptation  to  too  long  and  too  fast  riding  be 
resisted. 


CHAFER  VI. 

SLEEP. 

FOR  some  time  after  birth  infants  spend  the  inter- 
vals between  being  fed,  washed  and  dressed,  in 
sleep,  and  thus  pass  eighteen  or  twenty  out  of  the 
twenty-four  hours.  As  age  advances,  the  amount 
of  sleep  required  becomes  less,  until  at  two  years 
fourteen  hours,  and  at  three  years  twelve  hours,  are 
enough.  The  amount  of  sleep  required  will,  how- 
ever, vary  condiserably  in  different  children,  but  an 
observant  mother  can  soon  determine  this  question 
for  herself. 

Any  marked  diminution  in  the  average  duration 
of  sleep,  or  any  decided  restlessness  indicate  dis- 
ease, and  demand  attention  from  the  physician.  At 
the  same  time,  sleep,  perhaps  more  than  any  other 
item  of  nursery  regimen,  is  a  matter  of  training, 
and  many  a  mother,  by  want  of  judicious  firmness, 
has  rendered  the  early  years  of  her  child's  life  not 
only  a  burden  to  himself,  but  an  annoyance  to  the 
entire  household. 

One  cannot  too  soon  begin  to  form  the  good  habit 
of  regularity  in  sleeping  hours,  and  so  far  as  circum- 
stances admit,  the  following  rules  may  be  enforced : 
in 


112  HYGIENE   OF   THE   NURSERY 

From  the  second  week  to  the  end  of  the  sixth  or 
eighth  month  the  infant  must  sleep  from  10  p.  M.  to 
6  A.  M.,  and  as  many  hours  during  the  day  as  nature 
demands  and  the  exigencies  of  the  nursery  permit. 
This  does  not  mean  that  the  baby  is  not  to  be  put 
to  bed  until  nearly  midnight;  on  the  contrary,  he 
should  practically  settle  for  the  night  at  six  o'clock, 
but  the  last  feeding  should  be  at  ten  o'clock.  After 
this  he  must  rest  undisturbed  with  the  exception, 
sometimes,  of  one  night  feeding,  during  the  first  six 
months,  until  the  early  morning  hour,  when  he 
should  be  fed  and  sleep  again.  During  the  day, 

6  A.  M.  to  6  P.  M.,  the  baby  should  be  trained  to 
sleep   between   feedings,   being    promptly   roused 
when  the  regular  hour  arrives. 

From  eight  months  to  the  end  of  two  and  a  half 
years,  a  morning  nap  should  be  taken,  say  from  12 
to  1.30  or  2  p.  M.,  the  child  being  undressed  and 
put  to  bed.  Occasionally  an  afternoon  nap  for  half 
an  hour  or  more  seems  necessary,  although,  as  a  rule, 
sleep  at  night  is  more  undisturbed  and  refreshing 
if  this  be  omitted.  The  night's  rest  must  begin  at 

7  P.  M.     If  a  late  meal  be  required,  the  child  can  be 
taken  up  at  about  ten  o'clock,  but  if  past  the  age 
for  this,  he  may  sleep  undisturbed  until  he  wakes 
of  his  own  accord,  sometime  between  6  and  8  A.  M. 
As  soon  as  thoroughly  awake  the  child  must  be 
taken  up,  washed  and  dressed,  and  given  breakfast. 


SLEEP  113 

This  is  the  only  way  to  cultivate  the  habit  of  early 
rising,  which  promotes  both  bodily  and  mental  wel- 
fare, and  of  all  habits  is  the  most  conducive  to  a 
long  and  healthy  life. 

By  early  rising  it  is  not  meant  that  the  child  shall 
be  roused -from  a  sound  sleep  by  a  rough  voice  or 
hand  at  a  certain  fixed  hour  in  winter  and  an  ear- 
lier one  in  the  summer,  simply  for  the  whim  of  a  fad- 
ridden  and  overprompt  parent.  Quite  the  reverse. 
Let  the  child  wake  of  his  own  accord,  for  he  will  do 
so — whether  it  be  late  or  early — after  he  has  had 
enough  sleep;  and,  if  he  must  get  up  at  a  certain 
hour — and  never  fix  it  before  7  A.  M. — make  the 
rousing  process  as  gentle  and  gradual  as  possible. 
Sudden  rousing  excites  the  brain,  quickens  the  pul- 
sation of  the  heart,  and,  if  repeated,  may  lead  to 
serious  consequences. 

From  two  and  a  half  to  four  years,  an  hour's 
sleep  may  or  may  not  be  taken  in  the  morning, 
according  to  the  disposition  and  needs  of  the  sub- 
ject, but  a  child  should  invariably  be  put  to  bed  at 
seven  in  the  evening  and  not  be  permitted  to  rise 
until  six  or  seven  o'clock  on  the  following  morn- 
ing. 

After  the  fourth  or  fifth  years,  few  children  will 
sleep  in  the  daytime;  they  are  ready  for  bed  by  8 
p.  M.,  and  must  be  allowed  to  sleep  for  ten  hours  or 
more. 
8 


114  HYGIENE    OF    THE   NURSERY 

A  later  retiring  hour  than  9  p.  M.  ought  never  to 
be  encouraged  until  after  the  twelfth  or  fifteenth 
year.  Any  postponement  of  the  usual  hour  for 
going  to  bed  is  injurious,  and  should  abridgment 
of  sleep  be  accompanied  by  the  excitement  of  a 
child's  party,  or  the  like,  the  rest  obtained  is  broken 
and  productive  of  a  pale  face  and  nerveless  frame 
on  the  succeeding  day. 

The  position  and  general  features  of  the  night 
nursery  have  already  been  described,  and  it  only 
remains  to  say  that  when  occupied  by  day  it  must 
be  darkened  so  as  to  favor  sound  sleeping. 

The  bed  (and  where  there  are  several  children 
in  the  family  each  should  have  its  own)  must  be 
so  situated  in  the  room  as  to  be  out  of  the  way  of 
draughts.  Curtains,  while  they  protect,  prevent 
the  access  of  fresh  air,  and  it  is  far  better  to  ward 
off  a  draught  by  a  movable,  folding  screen. 

The  form  of  bed  known  as  a  crib  may  be  occupied 
until  the  sixth  year.  The  sides  must  be  high,  to 
prevent  the  child  from  falling  out  and  injuring 
himself,  and  the  movable  side  should  work  upon 
hinges  or  move  up  and  down  in  slots. 

Springs  and  a  soft  horsehair  mattress,  protected 
by  a  gum  cloth,  placed  beneath  a  double  sheet, 
under  ordinary  circumstances  constitute  the  bed 
proper.  Sometimes  a  feather  mattress  is  admissi- 
ble, but  this  is  only  when  the  child  is  feeble,  and 


SLEEP  115 

requires  artificial  aid  to  keep  up  the  normal  body- 
heat  during  sleep. 

The  objection  to  feathers  is,  that  the  body,  sink- 
ing deeply  in,  is  so  completely  enveloped  that  it  is 
subjected  to  an  undue  degree  of  heat,  which  relaxes 
and  weakens  the  system  and  renders  it  very  sus- 
ceptible to  the  injurious  influences  of  cold. 

The  bed  covering  is  composed  of  a  sheet,  one  or 
more  blankets — according  to  the  weather — and  a 
spread.  These  must  be  warm  enough  to  maintain 
a  healthy  temperature,  but,  at  the  same  time,  not 
so  heavy  as  to  oppress  the  child. 

Special  care  should  be  taken  not  to  cover  the 
nose  or  mouth,  and  it  is  much  better  to  keep  the 
air  of  the  nursery  at  a  proper,  even  temperature  by 
an  open  fire  than  to  secure  warmth  to  the  body 
alone  by  weighty  bed  coverings. 

A  pillow  ought  not  to  be  used  with  young  infants, 
later  it  must  be  small  and  thin,  and  made  of  soft 
horsehair. 

The  bed  should  never  be  made  up  directly  upon 
the  child's  leaving  it,  for  then  it  is  saturated  with  the 
nocturnal  exhalations  from  the  body.  When  va- 
cated, the  bed  coverings  must  be  thrown  over  the 
backs  of  chairs,  the  mattress  shaken  up,  and,  the 
windows  of  the  chamber  being  thrown  open,  allowed 
to  air  for  an  hour  or  more. 

In  the  matter  of  bed  clothing,  cleanliness  is  as 


Il6  HYGIENE    OF   THE   NURSERY 

important  as  in  body  clothing,  and  the  nurse  must 
never  neglect  to  remake  a  bed  if  the  sheets  become 
wet  with  urine  or  otherwise  soiled,  no  matter  at 
what  hour  of  the  night  the  accident  may  occur. 
Much  trouble  in  this  direction  may  be  avoided, 
however,  by  regularly  taking  up  the  child  at  the 
time  of  the  last  feeding  and  encouraging  a  through 
evacuation  of  the  bladder. 

Children  should  never  sleep  in  the  same  room 
with  persons  who  are  ill,  whether  the  disease  be 
acute  or  chronic.  Sleeping  with  those  having  a 
long-standing  cough  or  consumption  of  the  lungs 
is  especially  to  be  avoided.  Do  not  get  the  baby 
into  the  habit  of  being  rocked  or  walked  to  sleep, 
and  do  not  allow  older  children  to  sleep  too  soon 
after  a  meal,  as  the  processes  of  digestion  are  apt 
to  produce  restlessness  and  uneasiness.  Again,  a 
bright  light  or  loud  conversation  in  the  bedroom 
should  never  be  permitted  after  the  children  have 
settled  to  rest;  but  they  should  be  taught  to  sleep 
through  any  ordinary  noise,  as  the  sound  of  foot- 
steps or  low  talking. 

Finally,  teach  the  nurse  to  make  up  the  bed 
neatly  and  smoothly,  and  direct  her  to  turn  the  pil- 
low and  smooth  out  the  sheets,  should  her  charge 
be  restless  at  night.  By  this  latter  procedure  sound 
sleep  is  often  brought  to  a  fretful  child. 

Sleeping   out-of-doors,   in   suitable   weather,    is 


SLEEP  117 

very  health  giving.  In  summer,  between  7  A.  M. 
and  7  p.  M.  an  infant  of  one  month  may  sleep  in  the 
open  air  in  its  coach  placed  in  a  sheltered  position. 
In  winter,  between  9  A.  M.  and  4  p.  M.,  when  the  sun 
is  shining  and  the  mercury  above  32°  F.,  a  baby 
four  months  old,  being  well  wrapped  up,  may  sleep 
in  its  carriage  on  a  porch  or  some  other  protected 
place. 


CHAPTER  VII. 

BATHING. 

A  well-known  English  writer  states  that  "water 
to  the  body — to  the  whole  body — is  a  necessity  of 
life,  of  health,  and  of  happiness;  it  wards  off  dis- 
ease, it  braces  the  nerves,  it  hardens  the  frame,  it  is 
the  finest  tonic  in  the  world." 

On  the  word  "tonic"  the  whole  subject  hinges. 
Every  one  knows  that  food,  even  in  such  a  simple 
form  as  milk,  may  be  given  to  excess,  with  the  pro- 
duction of  illness,  and  that  medicines  are  yet  more 
easily  abused.  Why,  then,  if  the  bath  be  a  tonic 
agent,  may  it  not  be  often  used  injudiciously  and 
to  the  detriment  of  the  child? 

Intelligent  nurses,  who  have  grown  gray  in  ser- 
vice, often  say  they  have  seen  babies  "washed  into 
heaven."  This  act  has  never  been  actually  accom- 
plished in  my  experience,  but  it  has  been  often 
enough  approached  to  justify  introducing  this  chap- 
ter with  the  caution  that,  should  the  infant  be  ailing, 
the  bath  had  better  be  discontinued  until  the  phy- 
sician can  be  consulted.  This,  of  course,  does  not 
preclude  ordinary  cleanliness,  for  every  part  of  the 
118 


BATHING  IIQ 

child's  body  liable  to  become  soiled  can  be  readily 
cleaned  by  the  use  of  a  moist  sponge,  with  or  with- 
out soap,  and  without  bringing  into  play  any  of 
the  medicinal  or,  in  other  words,  tonic  effects  of 
the  bath. 

The  initial  bath  differs  from  those  that  succeed 
it  during  infancy  in  the  fact  that  it  involves  a  special 
procedure,  namely,  the  removal  of  the  vernioc  caseosa, 
a  tenacious,  white  paste-like  material,  which  usually 
adheres  to  the  skin  of  the  new-born.  This  should 
be  removed  as  soon  after  birth  as  the  nurse,  having 
made  the  mother  comfortable,  can  turn  her  atten- 
tion to  the  child,  and  this  process  consists  in  first 
rubbing  the  whole  surface  gently,  though  thor- 
oughly, with  a  bit  of  soft  flannel  covered  with  white 
vaseline  or  fresh  lard,  and  next  wiping  off  the 
softened,  greasy  coating  with  a  dry  piece  of  absorb- 
ent cotton,  or  a  very  soft  towel;  especial  care  being 
taken  to  thoroughly  clean  the  arm-pits,  and  the 
creases  back  of  the  ears  and  in  the  groins  and 
buttocks.  A  dry,  sterile  dressing  is  then  applied  to 
the  cord;  a  flannel  binder  adjusted;  the  face  washed 
with  warm  water  and  a  soft  wash  cloth  or  absoibent 
cotton;  the  baby  enveloped  in  a  warmed  blanket, 
laid  in  its  crib,  on  its  right  side,  in  a  quiet  and 
darkened  room,  and  allowed  to  sleep  for  six 
hours. 

After  this  preliminary  cleansing,  one  bath  a  day 


I2O  HYGIENE   OF   THE   NURSERY 

should  be  the  rule  until  the  completion  of  the  third 
year  of  life. 

For  the  first  ten  days  the  infant  must  be  bathed 
on  the  lap,  or  "sponged,"  a  full  tub-bath  never 
being  given  until  the  cord  has  fallen  off  and  the 
navel  healed.  For  the  first  bath  the  water  should 
have  a  thermometer  measured  temperature  of 
100°  F.,  the  same  water  must  not  be  used  in  washing 
the  body,  and  the  face  and  head,  or  the  reverse, 
and  in  giving  the  bath  the  abdominal  binder  is 
neither  to  be  removed  nor  allowed  to  become  wet. 
The  nurse,  seated  on  a  low  chair  with  her  gown 
protected  with  an  upper  flannel  and  an  under  rubber 
apron,  should  take  the  infant,  naked  with  the  excep- 
tion of  the  binder  and  wrapped  in  a  warmed  blanket, 
upon  her  lap  and  proceed  in  the  following  way: 
Wash  the  face  and  head  with  warm  water — no  soap 
— and  a  wash  cloth  and  carefully  dry.  Clean  the 
eyes  by  squeezing  a  solution  of  boric  acid  (one 
teaspoonful  to  four  ounces  of  water)  from  a  thor- 
oughly saturated  bit  of  absorbent  cotton  into  the 
inner  corner  of  each  eye  letting  it  run  under  the  lids, 
the  infant  being  placed  on  its  back  and  the  head 
turned  to  the  right  for  the  right  and  the  left  for  the 
left  eye;  the  cotton  must  be  held  quite  close,  a  new 
piece  used  for  each  eye,  and  after  the  douching 
the  wet  cotton  is  passed  over  the  eyes  so  as  to 
gently  wipe  them.  The  infant  being  still  on  its 


BATHING  121 

back,  clear  the  nose  with  a  little  alboline  dropped 
from  a  medicine  dropper  into  each  nostril,  this 
causes  sneezing  with  the  expulsion  of  the  softened 
nasal  mucus.  Wash  the  mouth  with  a  small  swab 
of  absorbent  cotton  wet  with  normal  saline  solution, 
passing  it  gently  over  the  whole  surface,  including 
the  tongue,  gums,  cheeks  and  roof  of  the  mouth; 
the  nurse's  finger  must  never  be  used.  Clean  the 
ears,  so  far  as  possible  without  penetrating  the 
auditory  canal,  with  warm,  unsoaped  water  and  a 
soft  wash  cloth.  Next  bathe  the  body  with  castile 
soap  and  warm  water  applied  by  a  wash  cloth, 
being  careful  not  to  wet  the  binder,  then  wash 
away  the  soap  with  a  sponge,  and,  finally,  pat  the 
surface  dry  with  a  very  soft  towel.  With  girl  babies, 
clean  the  external  genitals,  each  day,  with  absorbent 
cotton  saturated  with  boric  acid  solution.  With 
boys,  the  foreskin  must  be  retracted  every  other 
day  and  the  parts  gently  bathed  to  remove  all 
secretions. 

The  daily  full  tub-bath  is,  as  already  stated, 
begun  after  the  navel  has  healed,  and  is  in  some 
of  its  details  similar  to  "sponging."  This  bath 
must  be  given  by  the  monthly  nurse  so  long  as 
she  remains  in  attendance;  afterward  the  mother  is 
the  proper  person,  unless  the  nurse-maid  be  excep- 
tionally careful  and  experienced;  and  even  in  this 
event  the  mother  should  superintend  the  process. 


122  HYGIENE    OF    THE   NURSERY 

A  tub  with  a  supply  of  water,  a  piece  of  soft 
flannel  for  a  wash-rag,  absorbent  cotton,  a  fine 
sponge,  a  bit  of  good  soap  and  several  soft  towels 
are  the  necessary  articles.  A  long  apron  made  of 
soft  flannel  is  also  useful,  and  it  is  well  to  provide  a 
low  chair  and  a  piece  of  oilcloth  to  place  on  the 
floor  underneath  the  tub.  The  former  enables  the 
bather  to  get  more  on  a  level  with  her  work  and 


FIG.   15. — BATH  TABLE. 
a,  a,  elastic  tapes  for  steadying  tub. 


make  a  deeper  lap  for  the  child  to  rest  in,  and  the 
latter  receives  any  water  that  may  be  splashed  about. 
A  stand  is  now  made  to  hold  the  baby's  bathtub, 
Fig.  15,  and  is  so  contrived  that  it  can  be  folded  up 
and  laid  away  when  not  in  use.  It  is  convenient, 
inasmuch  as  it  obviates  the  necessity  of  stooping 
over,  by  bringing  the  child  more  on  a  level  with  the 
bather.  It  has  straps  and  hooks  attached  to  the 
sides  to  hold  the  tub  firmly  in  place  while  in  use. 

An  ordinary  oblong  tin  tub,  painted  white  inside 
and  large  enough  to  give  plenty  of  room,  is  to  be 


BATHING  1 23 

preferred  to  either  a  porcelain  basin  or  a  wooden 
tub.  When  in  use,  the  tub  should  be  placed  on  the 
floor,  for  the  sake  of  firm  support,  or  on  the  bath 
table,  and  afterward  must  be  well  cleaned,  dried 
and  aired. 

Water  for  the  bath  ought  to  be  pure  and  soft,  and 
should  it  be  muddy  or  otherwise  foul,  the  nurse 
must  take  the  trouble  to  filter  it.  The  character  of 
softness  is  an  important  one,  and  when  it  is  impos- 
sible to  obtain  anything  but  hard  water  from  the 
ordinary  sources  of  supply,  a  special  provision 
ought  to  be  made  for  the  collection  of  rain  water. 
The  quantity  used  at  a  time  should  be  sufficient  to 
cover  the  child  up  to  the  neck  when  placed  in  the 
tub  in  a  semi-reclining  position. 

A  matter  of  great  importance  is  the  temperature 
of  the  water.  Some — fortunately  very  few — people 
use  cold  water  from  the  first,  under  the  impression 
that  it  is  strengthening.  So  far  from  this  being  the 
case,  cold  water,  instead  of  hardening,  depresses 
the  vital  forces  and  frequently  produces  inflamma- 
tion of  the  eyes,  nasal  catarrh,  and  inflammation  of 
the  lungs  and  bowels. 

While  cold  baths  are  not  to  be  recommended, 
one  must  not  go  to  the  other  extreme,  and  use  too 
hot  water;  for  this  also  weakens  the  frame  and 
renders  it  more  susceptible  to  the  attacks  of  disease. 

The   initial   temperature   of    100°   F.    must  be 


124 


HYGIENE   OF   THE   NURSERY 


maintained  in  subsequent  baths  until  the  child  is 
three  or  four  months  old,  and  then 
slowly  reduced,  so  that  by  the  end  of 
the  sixth  month  it  is  95°  and  through- 
out the  second  year  from  85°  to  90°, 
being  somewhat  lower  in  summer 
than  in  winter.  As  the  heat  of  water 
cannot  be  estimated  by  hand  with  any 
degree  of  accuracy,  it  is  essential  to 
use  a  bath  thermometer  (Fig.  16). 

Place  this  instrument  in  the  water 
and  allow  it  to  remain  a  few  moments, 
so  as  to  get  a  full  effect  upon  the 
mercury.  Should  the  water  be  too 
hot,  it  may  be  readily  cooled  by  the 
addition  of  cold  water,  or,  if  too  low 
in  temperature,  is  easily  raised  to  the 
proper  degree  by  pouring  in  hot  water. 
It  is  impossible  to  insist  too  strongly 
upon  the  necessity  of  uniformly  using 
the  bath  thermometer.  Several  times 
in  my  experience  a  tin  bathtub  has 
been  filled  with  water  so  hot  that  its 
sides  burned  the  delicate  skin  of  the 
little  hand  placed  upon  it.  Fortu- 
nately, in  such  instances,  the  conse- 
quent screams  led  to  careful  investi- 
gation, and  no  serious  damage  resulted.  On  the 


FIG.  16. — BATH 
THERMOMETER. 


BATHING  125 

other  hand,  I  have  felt  the  water  cold  enough  to 
pain  the  fingers.  Don't  neglect  the  thermometer, 
then! 

A  piece  of  flannel  is  very  useful  for  the  first  part 
of  the  bathing.  It  readily  takes  soap,  and,  being 
soft,  can  be  thoroughly  rubbed  over  the  skin  with- 
out danger  of  injury.  A  large,  soft  sponge,  how- 
ever, is  best  suited  to  the  finishing  of  the  bath,  for 
it  holds  more  water  than  a  flannel  wash-rag,  and 
enables  the  bather  to  stream  the  water  over  the 
child's  body,  and  thus  get  the  stimulating  effect  of 
a  miniature  shower  bath  at  the  same  time  that 
the  dirt  and  superfluous  soap  are  washed  away 
from  the  surface.  The  wash-rag  and  sponge  must, 
by  the  way,  be  the  child's  exclusive  property,  and 
are  not  to  be  used  twice  in  succession  without  being 
thoroughly  cleaned  and  dried  in  the  open  air. 

Unscented  Castile  or  glycerin  soaps  are  the 
best  to  use.  Common  soaps  are  irritating  to  the 
skin,  and  even  the  purest  and  most  bland  articles 
must  be  employed  with  care,  that  is,  neither  too 
frequently  not  too  profusely,  lest  they  lead  to  ec- 
zema or  other  cutaneous  disorders.  When  any  skin 
disease  is  present,  the  physician's  advice  must  be 
had  not  only  as  to  the  use  of  soap,  but  also  in  refer- 
ence to  the  propriety  of  the  bath  itself. 

Two  towels  are  required  for  each  bath.  These 
should  be  large  and  composed  of  fine,  soft  material. 


126  HYGIENE   OF   THE   NURSERY 

They  must  be  dry  and  warm,  and  perfectly  clean 
before  they  are  applied  to  the  surface  of  the 
child. 

The  bath  apron  should  be  made  of  two  pieces  of 
soft,  white  flannel;  one  long  enough  to  extend  from 
the  waist  almost  to  the  feet  of  the  bather,  and  broad 
enough  to  completely  cover  the  front  of  her  gown; 
the  other  quite  as  broad  but  about  four  inches 
shorter.  Both  pieces  are  sewed  to  a  waist  belt, 
forming,  in  reality,  two  aprons;  the  upper  of  which 
is  thrown  over  the  shoulder  when  the  infant  is  being 
lifted  from  the  tub,  and  then  used  as  a  dry  and 
warm  covering  when  he  reaches  the  lap.  After  the 
bath,  the  apron,  being  more  or  less  wet,  must  be 
taken  off  and  thoroughly  dried.  Several  such  arti- 
cles should  be  provided,  as  they  must  be  frequently 
washed  to  keep  then  clean  and  free  from  odors. 

Any  low  chair  will  do  to  use  in  bathing,  although 
as  those  usually  sold  have  not  a  sufficiently  broad 
seat  to  give  a  comfortable  support,  it  is  better  to 
make  one  by  sawing  off  the  legs  of  an  ordinary 
wooden  kitchen  chair. 

The  bath  must  be  given  at  a  regular  time  each 
day.  The  best  hours  are  in  the  morning,  midway 
between  two  feedings,  and  in  the  evening,  just 
before  the  infant  gets  his  last  feeding  and  goes  to 
bed.  The  first  is  perhaps  the  better  hour,  but 
regularity  is  the  more  important  point. 


BATHING  127 

At  the  time  selected,  place  the  tub  containing  the 
water,  heated  to  a  proper  temperature,  in  a  warm 
and  sheltered  part  of  the  room,  and  around  it  ar- 
range, within  convenient  reach  of  the  hand,  the 
various  requisites  of  the  bath. 

Upon  undressing  the  child,  wet  his  head  first; 
then  let  the  head  and  shoulders  rest  on  the  left 
forearm  and  lower  the  child  gently  into  the  water, 
that  his  body  may  be  covered  as  far  as  his  neck. 
Take  a  wetted  and  soaped  flannel  wash-rag  in  the 
right  hand  and  pass  it  rapidly  but  thoroughly  over 
the  body,  avoiding  the  eyes.  Pay  particular  at- 
tention to  the  arm-pits,  to  the  region  between  the 
folds  of  the  buttocks  and  to  the  groins.  This  done, 
take  a  large,  well-filled  sponge  in  the  right  hand  and 
squeeze  the  contents  over  the  body.  The  chief 
force  of  this  miniature  douche  must  fall  upon  the 
back  and  loins,  and  the  child,  during  the  operation, 
must  be  lifted  clear  of  the  bath-water  by  the  left  arm 
and  hand. 

The  sponge  is  used  simply  to  clear  off  the  dirt 
loosened  by  the  wash-rag,  and  to  remove  all  super- 
fluous soap;  therefore,  when  this  is  accomplished, 
the  child  shou]d  be  lifted  from  the  tub  to  the  lap 
and  enveloped  in  a  towel,  or,  better  still,  in  the 
loose  folds  of  the  bath-apron.  The  drying  process 
now  begins  and  consists  in  absorbing  the  moisture 
from  the  skin.  This  is  done  by  a  series  of  very 


128  HYGIENE   OF   THE   NURSERY 

gentle  patting  movements  with  a  towel  folded  over 
the  palm  of  the  hand.  In  drying  a  baby,  special 
attention  must  be  given  to  those  portions  of  the 
body  where  the  natural  folds  form  crevices  in  which 
water  may  lodge.  Unless  these  parts  be  thoroughly 
dried,  serious  consequences  may  ensue.  If  it  be 
retained  in  a  normal  crevice — the  fold  of  the  but- 
tocks or  behind  the  ears — it  causes  in  a  short  time 
troublesome  excoriation. 

"Never  allow  anything  smaller  than  the  elbow  to 
enter  the  ear"  is  excellent  advice;  although  during 
the  bath  should  water  get  in  and  be  allowed  to  re- 
main it  may  lead  to  earache  and  abscesses,  and 
in  extreme,  though  not  rare,  cases,  to  deafness. 
In  the  event  of  this  a  blunt  cone  formed  out  of  a 
soft  handkerchief  or  of  absorbent  cotton  will  quickly 
absorb  the  moisture,  and  will  do  no  harm  if  inserted 
but  a  very  short  distance  within  the  orifice. 

The  nose  can  readily  be  cleaned  by  dropping 
alboline  into  the  nostrils,  or  by  the  very  careful 
use  of  a  small  cotton  swab,  especially  if  a  little 
vaseline  be  added  to  facilitate  the  process.  The 
mouth  must  be  washed  in  the  way  already  described, 
with  a  swab  of  absorbent  cotton,  and  this  is  to  be 
done  only  twice  daily,  not  before  or  after  each 
feeding.  The  male  and  female  genitals  must 
receive  the  same  attention  as  in  "  sponging,"  but 
in  regard  to  the  former,  after  the  first  year  it  is 


BATHING  129 

quite  sufficient  to  retract  the  foreskin  and  wash  the 
parts,  once  or  at  most  twice  a  week. 

After  the  infant  is  patted  perfectly  dry— not  rudely 
rubbed  with  a  towel — the  whole  surface,  but  es- 
pecially the  region  on  either  side  of  the  spine,  should 
be  rubbed  with  the  naked  palm  until  the  skin  be- 
comes slightly  red.  This  modified  massage  ends  the 
bath,  and  the  child  must  then  be  dressed  as  quickly 
as  possible. 

Several  important  points  yet  remain  to  be  men- 
tioned. Never  give  a  bath  immediately  after  a 
meal  nor  when  the  child  is  either  cold  or  overheated. 
Never  suddenly  or  rudely  plunge  the  body  into  the 
water;  never  allow  the  time  of  actual  immersion 
to  exceed  five  minutes,  and  during  the  first  three 
months  limit  it  to  two  minutes.  Under  no  circum- 
stances should  the  head  and  face  be  allowed  to  dip 
beneath  the  surface.  Should  this  happen,  the  child 
will  become  so  frightened  that  it  will  be  difficult 
to  get  him  to  enter  the  water  again.  And  here,  by 
the  way,  it  may  be  well  to  state  that  if  there  be  repug- 
nance to  the  bath,  the  tub  may  be  covered  over  with 
a  blanket,  and  the  child,  being  placed  upon  it,  may 
be  slowly  lowered  into  the  water  without  seeing 
anything  to  excite  his  fears. 

While  the  infant's  head  should  be  wet  before  each 
bath,  it  must  not  be  washed  every  day.  Too  fre- 
quent cleaning  and  the  too  frequent  use  of  soap  dry 


130  HYGIENE    OF   THE   NURSERY 

the  skin  and  lead  to  seborrhoea  or  other  cutaneous 
disorders;  once  a  week  is  quite  often  enough  to 
wash  the  scalp.  The  buttocks  and  thighs  require 
bathing  after  each  bowel  movement;  this  should  be 
done  with  simple  warm  water  and  absorbent  cotton, 
and  after  the  parts  are  thoroughly  cleansed  they 
must  be  as  carefully  dried  before  adjusting  a  fresh 
napkin. 

The  question  of  the  propriety  of  using  powder 
after  a  bath  is  often  asked  by  mothers.  Powdering 
has  always  seemed  to  me  to  be  a  lazy  way  of  absorb- 
ing the  moisture  that  should  be  taken  up  by  a  dry 
towel,  and  unless  there  be  some  excoriation  or  other 
indication  for  its  use,  the  skin  can  be  kept  cleaner 
and  healthier  without  it.  In  cases,  too,  in  which 
some  disorder  of  the  skin  would  seem  to  warrant  its 
employment,  better  and  quicker  results  are  ordi- 
narily obtained  by  the  application  of  cold  cream, 
oxide  of  zinc  ointment,  or  vaseline. 

The  rule  of  one  bath  a  day  may  be  exceeded  in 
very  hot  weather,  when,  in  addition  to  the  morning 
full  bath,  the  body  may  be  sponged  twice  daily  with 
water  at  a  temperature  of  85°  to  90°  F.  This,  con- 
trary to  what  might  be  expected,  has  a  greater  and 
more  permanently  cooling  effect  than  bathing  with 
cold  water. 

From  what  has  been  written,  one  might  suppose 
that  the  details  of  an  infant's  bath  are  endless.  So 


BATHING  131 

they  must  seem  when  given  in  full.  A  skilful  bather, 
however,  ought  to  fulfil  every  requisite  and  com- 
plete the  bath  in  a  period  of  time  not  exceeding 
twenty  minutes  at  the  very  outside,  and  this  must 
include  not  only  the  actual  five  minutes'  immersion, 
but  the  preparation  of  the  bath  and  the  drying 
process. 

The  full  bath  should  be  omitted  under  the  follow- 
ing conditions:  in  all  cases  of  acute  illness  until 
the  physician  has  seen  the  child;  when  there  is 
eczema  or  other  skin  affection,  and  in  feeble  and 
delicate  infants  to  avoid  the  risks  of  exposure^and 
fatigue. 

After  the  third  year  three  full  baths  a  week  are 
quite  sufficient.  An  evening  hour  is  now  to  be 
preferred,  but  the  water  must  be  heated  to  90°  F. 
in  winter,  though  it  may  be  cooler  in  the  heat 
of  summer.  While,  at  this  age,  the  child  has  his 
three  full  baths  weekly,  for  the  purpose  of  securing 
absolute  cleanliness  he  must  be  sponged  every  day 
with  water,  cool  or  warmed  to  the  season. 

The  sponge  bath  is  best  given  in  the  morning, 
soon  after  the  child  has  roused  himself  from  sleep 
and  before  any  food  is  given.  The  nurse,  for  this, 
must  provide  herself  with  a  large  basin  containing 
water  at  a  temperature  of  75°  in  summer  and  85° 
in  winter,  a  large,  fine  sponge  and  several  towels. 
The  bath-apron  being  donned  and  the  child's  night- 


132  HYGIENE   OF   THE   NURSERY 

clothes  removed,  the  sponge  filled  with  water  is 
passed  rapidly  over  the  whole  surface  of  the  body; 
then  the  child  must  be  wrapped  up  in  the  apron 
and  the  skin  first  dried  gently  with  a  soft  towel  and 
then  rubbed  into  redness  with  the  open  hand. 
When  this  process  is.  completed — and  it  should  be 
done  in  at  least  ten  minutes — the  clothing  is  put  on 
rapidly,  and  the  child  is  ready  and  usually  hungry 
for  his  morning  meal.  No  soap  need  be  used  in 
these  baths. 

In  the  tri-weekly  cleansing  bath  the  process  of 
washing  is  much  the  same  as  in  infancy.  That  is, 
the  bathtub  being  filled  with  water  at  a  temperature 
of  about  90°,  the  child  is  put  into  it  up  to  his  neck 
and  thoroughly  soaped  with  a  wash-rag,  and  next 
douched  clean  with  a  large  sponge.  Here,  also, 
the  head  must  be  wet  first;  the  body  immersion 
must  not  last  longer  than  five  minutes,  and  the  dry- 
ing must  be  done  quickly  and  with  a  patting  rather 
than  a  rubbing  movement.  Ample  reaction  of  the 
skin  must  be  secured  by  gently  rubbing  with  the 
palm  of  the  hand,  especially  over  the  spine. 

The  washing  of  the  head  is  a  most  important 
matter,  as  it  cleanses  the  scalp,  prevents  the  for- 
mation of  scurf,  and  adds  beauty  to  the  hair.  At 
the  same  time  the  nurse  must  be  careful  how  she 
dries  the  hair.  To  rub  it  gently  with  a  soft  towel 
and  then  brush  it  out  with  a  fine  hair  brush  is  the 


BATHING  133 

proper  plan.  Combing,  in  so  far  as  it  means  dress- 
ing the  hair  and  cleansing  the  scalp  with  a  fine 
comb,  must  never  be  allowed,  as  it  not  only  thins 
the  hair  by  pulling  it  out  by  the  roots,  but  also 
irritates  the  scalp  and  produces  eruptions  upon  it. 

As  the  child  approaches  puberty  he  must  gradu- 
ally be  taught  to  wash  himself,  and  should  be  en- 
couraged to  form  the  habit  of  bathing  every  day. 
The  bath  at  this  age  should  be  a  sponging  rather 
than  a  soaking  process;  it  is  best  taken  in  the  morn- 
ing directly  after  rising,  and  the  temperature  of  the 
water  may  range  from  65°  to  75°,  though  delicate 
children  may  require  it  warmer,  especially  during 
winter  weather. 

When  childhood  merges  into  youth,  while  the 
sponge  is  still  preferable  to  the  plunge,  water  may 
be  used,  all  the  year  round,  just  as  it  flows  from  the 
faucet.  The  temperature  will  be,  of  course,  quite 
low  at  times,  but  so  long  as  the  bath  is  taken  in  a 
warm  room,  completed  quickly,  and  followed  by  a 
sense  of  stimulation  and  warmth,  nothing  but  good 
results. 

Whatever  room  be  used  for  the  purpose  of  the 
toilet,  the  child,  if  he  be  old  enough  to  bathe  him- 
self, should  occupy  it  alone,  so  that  the  whole  body 
may  be  stripped  naked;  otherwise  washing  cannot 
be  thoroughly  or  effectually  accomplished. 

A  boy  should  wash  his  head  each  morning;  a 


134  HYGIENE    OF    THE   NURSERY 

girl,  who  has  long  hair,  at  least  once  a  week.  Any 
loitering  over  the  bath  is  attended  with  the  danger 
of  chilling.  Never  occupy  more  time  than  fifteen 
minutes  in  the  whole  process. 

These  daily  sponge  baths  are  ordinarily  quite 
sufficient  to  keep  the  person  perfectly  clean.  Some- 
times, however,  it  is  necessary  to  take,  in  addition, 
a  full  warm  bath  at  intervals  of  a  week.  These 
baths  are  relaxing  if  too  prolonged;  ten  minutes  is 
the  maximum  time  for  remaining  in  the  water. 
After  leaving  the  tub  there  must  be  no  exposure  to 
draughts.  The  best  hour  for  such  a  bath  is  in  the 
evening;  some  time  after  the  last  meal  and  just 
before  going  to  bed. 

Sea-water  baths  are  useful  for  a  child  of  any  age, 
although  ordinary  sea  bathing  is  not  to  be  recom- 
mended until  the  child  is  old  enough  and  strong 
enough  to  hold  his  own  in  a  moderate  surf — after 
the  eighth  year,  for  instance.  A  younger  subject 
may,  when  at  the  seaside,  be  dressed  daily  in  a 
bathing  suit  and  allowed  to  splash  for  a  time  at  the 
edge  of  the  surf.  The  process  of  carrying  a  child 
against  his  will  into  the  waves  and  immersing  his 
head,  as  is  often  done,  is  cruel  and  productive  of 
so  much  terror  that  more  harm  than  good  results. 

In  our  climate,  the  proper  season  for  sea  bathing 
is  from  the  middle  of  June  until  the  middle  of 
September. 


-      BATHING  135 

On  arriving  at  the  coast,  it  is  always  well  to  pre- 
pare for  the  plunge  in  the  sea  by  giving,  on  the 
first  day,  a  warm  salt-water  bath.  On  the  day 
following,  about  three  hours  after  breakfast,  the 
child  may  don  his  bathing  dress.  Immediately  on 
entering  the  water,  the  head  must  be  thoroughly 
wetted.  After  this,  the  bath  may  be  protracted  for 
fifteen,  or  at  most  twenty,  minutes.  To  get  the 
invigorating  effects  of  a  surf  bath,  it  should  never 
be  repeated  oftener  than  once  a  day,  and  in  some 
cases  it  is  better  to  allow  a  day  to  intervene,  or  even 
to  enter  the  water  only  twice  a  week.  Drying  and 
dressing  should  be  rapidly  performed,  and  a  half- 
hour's  brisk  walk  is  very  useful  in  promoting  re- 
action and  causing  free  circulation  of  the  blood. 
Should  the  bather  feel  faint  after  coming  out  of  the 
water,  he  must  be  wrapped  in  towels  and  given  half 
a  tumblerful  of  milk  containing  one  or  more  tea- 
spoonfuls  of  brandy  or  whisky,  and  the  succeeding 
baths  should  be  at  longer  intervals  and  for  shorter 
periods,  or  the}  must  be  discontinued  if  their  effect 
is  uniformly  depressant,  and  a  daily  sponge  bath 
of  equal  quantities  of  salt  and  fresh  water  substi- 
tuted. When  the  child  is  either  cold  or  perspiring 
freely,  the  bath  must  not  be  undertaken. 

The  bathing  suit  should  be  of  light  flannel,  made 
in  one  piece  like  a  pair  of  moderately  loose  night 
drawers,  but  with  short  arms  and  legs;  it  should 


136  HYGIENE    OF   THE   NURSERY 

open  only  over  the  shoulders,  where,  when  put  on, 
it  is  fastened  by  buttons.  This  arrangement  permits 
of  easy  removal  after  the  bath  when  the  flannel  is 
saturated  with  sea  water,  and  is,  in  consequence, 
heavy  and  sticky. 

The  question  of  sea  bathing  suggests  that  of 
swimming.  Boys,  and  girls  too,  should  early 
learn  to  swim.  The  art  is  not  only  a  safeguard,  but 
a  means  of  most  pleasant  and  invigorating  exercise. 
It  develops  the  muscles,  expands  the  chest,  aids 
digestion,  strengthens  the  whole  frame,  and  pro- 
motes energy,  courage  and  self-reliance. 

Swimming,  like  every  other  exercise,  must  be 
taken  in  moderation.  Even  with  this  care  it  is  not 
always  beneficial.  The  bather  should  leave  the 
water  experiencing  a  pleasant  glow  over  the  whole 
surface  of  the  body;  the  spirits  and  appetite  should 
be  increased,  and  there  ought  to  be  a  sensation  of 
augmented  strength.  If,  on  the  contrary,  it  should 
disagree,  there  is  a  sense  of  chilliness,  with  lassi- 
tude and  depression  of  spirits;  the  face  is  pinched 
and  pale,  and  the  lips  and  finger-nails  are  apt  to 
look  blue. 

Swimming  in  salt  water  is  more  invigorating 
than  in  fresh.  Apart  from  the  different  quality  of 
the  two  waters,  the  battling  with  the  waves  in  the 
former  case  is  more  exhilarating,  and  the  sea  breezes, 
blowing  upon  the  body,  carry  with  them  health 


BATHING  137 

and  strength.  Every  one  must  have  noticed  the 
increased  softness  and  beauty  of  the  skin  and  the 
greater  lustre  of  the  hair  after  a  sojourn  at  the  sea- 
side. 

It  may  be  serviceable  next  briefly  to  detail  the 
different  baths  in  common  use  as  well  as  those  most 
often  directed  by  physicians,  with  some  reference  to 
their  effects  upon  the  system. 

Concerning  temperature,  the  bath  may  be: — 

1.  Cold,  temperature  50°  to  65°  F. 

2.  Cool,  temperature  65°  to  75°  F. 

3.  Temperate,  temperature  75°  to  85°  F. 

4.  Tepid,  temperature  85°  to  92°  F. 

5.  Warm,  temperature  92°  to  98°  F. 

6.  Hot,  temperature  98°  to  112°  F. 

When  giving  a  cold  bath,  strip  the  child  in  a  warm 
room,  and  rub  him  thoroughly  with  the  palm  of  the 
hand  until  the  whole  body,  especially  the  spinal 
region,  is  warm.  Let  him  then  stand  in  a  tub  con- 
taining enough  hot  water  to  cover  the  feet,  and 
sponge  him  rapidly  with  cold  water.  The  tempera- 
ture of  the  latter  must  never  be  below  50°  F.,  and 
65°  is  usually  cold  enough.  The  addition  of  half 
an  ounce  of  rock  salt  or  a  tablespoonful  of  concen- 
trated sea  water  to  the  gallon,  renders  it  more  stimu- 
lating and  insures  a  complete  reaction.  After 
sponging,  the  surface  must  be  thoroughly  and 
quickly  dried  with  a  soft  towel  and  rubbed  with 
the  open  hand  until  aglow. 


138  HYGIENE    OF   THE   NURSERY 

This  bath,  provided  the  degree  of  cold  does  not 
exceed  the  resisting  powers  of  the  child,  is  a  power- 
ful tonic,  producing  rapid  tissue  changes  and  in- 
creasing nutrition.  Should  the  water  be  too  cold, 
or  the  sponging  continued  too  long,  reaction  does 
not  follow  the  primary  shock,  and  the  result  is  fa- 
tigue, exhaustion,  or  even  dangerous  prostration. 
This  bath,  therefore,  must  be  used  with  caution  and 
only  under  a  physician's  advice.  The  cases  in  which 
it  is  of  most  service  are  those  in  which  there  is  a 
sluggish  circulation  with  poor  appetite  and  feeble 
digestion;  in  which  the  nutrition  is  impaired, 
as  in  rickets,  and  in  certain  spasmodic  nervous 
disorders. 

A  cooled  bath  is  sometimes  prescribed,  and  may 
be  employed  with  advantage  in  conditions  attended 
with  very  high  fever.  The  child  is  first  immersed 
in  water  at  95°,  and  this  is  gradually  lowered  to  70° 
by  the  addition  of  cold  water,  the  process  occupy- 
ing from  fifteen  to  thirty  minutes. 

Analogous  to  this  bath  is  the  cold  pack.  Fold  a 
sheet  in  such  a  way  as  to  be  long  enough  to  extend 
from  the  child's  arm-pit  to  his  feet,  and  wide  enough 
to  encircle  completely  his  body;  dip  it  in  water  at 
90°  and  lay  it  smoothly  upon  a  cot,  the  mattress  of 
which  must  be  protected  by  a  rubber  mackintosh. 
When  all  is  in  readiness,  place  the  child  upon  the 
sheet,  and  wrap  it  around  his  body  and  legs.  A 


BATHING  139 

blanket  must  then  be  thrown  over  the  sheet  and  the 
pack  left  undisturbed  for  ten  minutes.  Then  lift 
the  child  out  quickly  and  envelop  him  in  a  warm 
blanket  and  allow  him  to  remain  at  rest  for  some 
little  time. 

In  the  absence  of  the  physician,  sponging  with 
water  at  a  temperature  of  85°  to  95°  is  the  only 
safe  bath  to  employ  to  reduce  temperature.  In 
giving  this  bath,  strip  the  child  and  place  him  in 
bed  between  blankets,  while  the  nurse,  inserting  her 
hand  between,  must  pass  a  damp  sponge  slowly 
over  the  surface.  Five  to  ten  minutes  may  be  con- 
sumed in  this  operation,  although  if  the  child  com- 
plain of  chilliness,  discontinue  the  sponging  at  once; 
a  sensation  of  cold,  too,  indicates  the  use  of  warmer 
water.  The  operation  may  be  repeated  several 
times  daily,  or  as  often  as  every  two  hours  in  urgent 
cases,  and  when  the  heat  reduction  is  of  short 
duration. 

The  hot  bath,  98°  to  112°,  is  employed  for  vari- 
ous purposes — to  relieve  nervous  irritability,  to 
promote  sleep,  to  produce  sweating,  and  to  draw 
the  blood  to  the  surface  in  the  event  of  congestion 
of  some  internal  organ.  Whether  a  full  bath  or 
merely  a  foot  bath  be  required,  five  minutes  is  suf- 
ficient time  for  immersion;  then,  with  or  without 
drying,  according  to  the  degree  of  sweating  desired, 
the  whole  body,  or  only  the  feet  and  legs  in  case 


140  HYGIENE   OF    THE   NURSERY 

of  a  foot  bath,  must  be  enveloped  in  a  blanket,  and 
the  child  put  to  bed.  To  render  these  baths  more 
stimulating,  a  teaspoonful  to  a  tablespoonful  of  mus- 
tard flour  may  be  added,  and  the  child  held  in  the 
water  until  the  arms  of  the  nurse  begin  to  tingle. 
The  hot  bath  is  purely  stimulating,  and  it  is  impor- 
tant not  to  continue  it  too  long,  lest  the  primary  and 
only  desirable  effect  be  followed  by  depression. 

The  blanket  bath  is  useful  in  producing  perspira- 
tion. Wring  a  blanket  out  of  hot  water  and  wrap 
it  around  the  child:  then  throw  three  or  four  dry 
blankets  over  him  and  leave  him  for  half  an  hour. 
Rub  the  body  then  with  a  soft  towel  to  absorb  the 
moisture  thoroughly,  and  keep  the  child  in  bed. 

There  are  several  medicated  baths  in  frequent 
domestic  use,  which  it  may  be  useful  to  describe. 

Mustard  Bath. — Take  from  two  teaspoonfuls  to 
two  tablespoonfuls  of  mustard  flour;  hot  water,  two 
to  four  gallons. 

In  the  form  of  a  foot  bath  it  produces  sweating  and 
determines  the  blood  to  the  surface.  As  a  general 
bath  it  acts  as  a  powerful  stimulant. 

Salt-water  Bath. — Take  four  tablespoonfuls  of 
rock  salt,  or  Ditman's  sea  salt,  or  concentrated  sea 
water;  water,  warm  or  cool,  according  to  season, 
four  gallons. 

To  be  used  as  a  general  bath  every  morning  in 
chronic  tuberculosis,  scrofula,  rickets,  and  general 


BATHING  141 

debility.  Bath  to  be  followed  by  thorough  rubbing 
of  the  surface,  especially  over  the  spine. 

Bran  Bath. — Take  one  pint  of  bran;  tie  up  in  a 
muslin  bag,  place  in  a  quart  of  water,  boil  for  an 
hour,  squeeze  bag  thoroughly  into  the  water,  and 
add  to  four  gallons  of  warm  water. 

Useful  in  eczema  and  other  skin  diseases. 

Soda  Bath. — Take  one  tablespoonful  of  bicar- 
bonate of  sodium;  warm  water,  four  gallons. 

Used  in  skin  affections. 

Hot  air  or  Vapor  Bath. — The  body-clothing 
being  removed  the  child  is  laid  upon  a  bed,  the  bed- 
clothing  is  pinned  tightly  about  the  neck  so  that  the 
head  only  is  outside,  and  raised  about  a  foot  above 
the  body  by  an  arrangement  of  hoops  or  a  wicker 
support.  Hot  air  or  vapor  is  then  introduced  be- 
neath the  raised  bed-covering  from  a  croup-kettle. 
This  bath  causes  free  perspiration  in  from  ten  to 
twenty  minutes,  and  may  be  continued  for  twenty  or 
thirty  minutes  unless  f  aintness  or  giddiness  be  pro- 
duced, when  it  should  be  stopped  at  once.  Such 
baths  are  especially  useful  in  case  of  suppression  of 
the  urine,  and  in  uremia. 

Disinfectant  Bath.* — Take  six  and  one-half 
ounces  of  liquid  carbolic  acid  (90%),  four  ounces 
of  glycerin,  and  four  gallons  of  warm  water  (98° 
F.) ;  or  six  ounces  of  solution  of  chlorinated  soda  and 

*See  Chapter  XI. 


142  HYGIENE   OF    THE   NURSERY 

six  quarts  of  warm  water.  Applicable  for  disinfec- 
tion of  the  person  after  an  attack  of  scarlatina  or 
other  contagious  disease.  Neither  of  these  solutions 
is  as  efficient  as  bichloride  of  mercury  in  the  pro- 
portion of  i  to  5000,  but  this  is  such  a  poisonous 
substance  that  it  should  never  be  used  without  a 
physician's  oversight. 

Compresses  are  often  useful.  The  wet  compress 
consists  simply  of  a  roll  of  flannel  or  soft  linen 
dipped  in  cold  or  hot  water,  according  to  circum- 
stances, and  wrung  out  and  then  applied  to  the  part 
indicated.  Cover  this  with  a  piece  of  oiled  silk 
rather  larger  than  the  compress. 

There  are  several  matters  that  bear  a  more  or 
less  close  relation  to  the  subject  of  bathing.  These 
are  the  care  of  the  teeth,  nails  and  hair. 

The  teeth  must  be  cleaned  morning  and  evening, 
and  the  cleaning  process  must  be  begun  with  the 
appearance  of  the  first  tooth.  Ordinarily,  a  soft 
wash  rag  folded  over  the  forefinger,  or  swab  of 
absorbent  cotton  dipped  in  cool  water  and  thor- 
oughly rubbed  over  the  teeth,  is  sufficient  to  keep 
the  early  teeth  clean,  and  does  not  injure  the  tender 
gums.  Should  a  dark-colored  scum  form  at  the 
junction  of  the  tooth  and  gum,  a  little  prepared 
chalk  or  other  bland  tooth  powder  may  be  used  in 
addition.  If  it  be  impossible  to  get  at  the  point  of 
discoloration  in  this  way,  shape  with  a  penknife  a 


BATHING  143 

moderately  hard  bit  of  wood  into  the  form  shown 
in  Fig.  17,  then  rub  the  woody  fibres  at  the  ex- 
treme end  into  a  sort  of  brush,  wet  this,  dip  it  in 
the  toothpowder  and  gently  rub  at  the  discolor- 
ation until  it  disappears,  taking  care  not  to  make 
the  gum  bleed.  Over  a  piece  of  wood  so  shaped 
one  may  also  wrap  a  bit  of  soft 
cambric  and  use  water  and  powder 
as  before. 

Take  good  care  of  the  milk  teeth, 
for  if  they  become  decayed  and 
broken  off  or  lost,  their  permanent 
substitutes  are  apt  to  come  in  ir- 
regularly and  produce  a  lasting 

,  FIG.  17— STICK  FOR 

deformity.  CLEANING  TEETH. 

The  tooth  brush  can  be  used 
after  a  number  of  the  milk  teeth  have  been  cut. 
The  bristles  should  be  very  soft  and  fine,  and  it 
must  be  employed  with  gentleness.  Unless  there 
should  be  some  discoloration,  no  powder  need  be 
used.  The  child  should  early  learn  to  clean  his 
own  teeth. 

The  importance  of  taking  care  of  the  toe-nails 
has  already  been  referred  to  in  the  chapter  on  cloth- 
ing. The  finger-nails  should  not  be  allowed  to 
grow  too  long;  at  the  same  time  it  is  a  bad  plan 
to  cut  them  close  to  the  quick.  In  trimming  them, 
use  a  moderately  dull  pair  of  scissors,  and  do  not 


144  HYGIENE   OF   THE   NURSERY 

round  them  too  much.  When  hang-nails  appear, 
they  must  be  cut  close  with  sharp  scissors.  The 
fingers  and  toes  should  be  inspected  carefully  after 
each  bath,  to  see  if  they  require  attention. 

Directions  have  already  been  given  in  regard  to 
washing  the  hair.  All  that  remains  to  be  said  now 
is  to  repeat  the  caution  against  the  use  of  a  fine 
comb,  and  to  protest  against  the  employment  of 
hair  oil  and  hair  washes.  The  best  scent  for  the 
hair  is  an  occasional  dressing  of  soap  and  water; 
the  best  beautifier  is  a  thorough  brushing  with 
good  brushes,  and  the  latter  should  be  employed 
every  morning  and  evening. 

Besides  keeping  the  long  hair  of  a  girl  free  from 
scent  and  grease,  do  not  dress  it  over  the  ears  or  tie 
it  up  tight  and  make  it  "  like  a  cap  of  iron  over  the 
skull." 

If  the  hair  be  well  brushed  and  the  scalp  thus 
sufficiently  stimulated,  there  will  be  enough  natural 
oil  secreted  to  keep  it  tidy;  artificial  oily  applications 
only  act  temporarily,  and  by  blocking  up  the  pores 
of  the  skin  tend  to  make  the  hair  drier  and  harder 
to  keep  in  order. 

Should  there  be  a  tendency  for  the  hair  to  fall 
out,  wash  the  scalp  thoroughly  and  frequently 
with  soap  and  water,  and  stimulate  it  by  firm 
brushing  and  the  use  of  a  wash  such  as  the  follow- 
ing: 


BATHING  145 

Take  of— 

Aromatic  spirit  of  ammonia i    fluidounce. 

Tincture  of  cantharides i|  fluidrachms. 

Glycerin |  fluidounce. 

Rose  water 7    fluidounces.     Mix. 

A  tablespoonful  of  this  may  be  rubbed  into  the 
scalp  once  every  day,  the  rubbing  to  be  followed  by 
washing  with  a  sponge  and  vigorous  brushing. 

In  such  cases,  however,  it  is  best  to  seek  the 
advice  of  a  physician,  for  falling  out  of  the  hair  may 
be  due  to  a  variety  of  causes. 


CHAPTER  VIII. 

FOOD. 

The  choice  of  food  and  the  method  of  feeding 
bear  so  close  a  relation  to  age  that  it  is  necessary, 
in  studying  these  questions,  to  regard  them  from 
the  stand-point  of  the  two  stages  of  a  child's  life 
mentioned  in  the  first  chapter;  that  is  to  say,  the 
periods  of  infancy  and  childhood. 

Infancy. — An  infant  may  be  fed  in  one  of  three 
ways:  i,  from  the  mother's  breast;  2,  from  the 
breast  of  a  foster-mother  or  wet-nurse;  and,  3, 
from  a  bottle,  by  the  method  known  as  artificial  or 
hand-feeding. 

i.  Feeding  from  the  maternal  breast. — There  can 
be  no  doubt  that  this,  being  the  natural,  is  at  the 
same  time  the  proper  method  of  nourishing  the 
human  infant;  and  fortunate  is  the  baby  that,  in 
our  day  of  advanced  civilization  and  city  living, 
can  draw  from  the  breast  of  a  robust  mother  an 
abundant  supply  of  pure,  health-giving,  tissue-build- 
ing food. 

It  follows,  therefore,  that  every  woman  who  is 
free  from  certain  contraindicating  diseases,  to  be 
146 


FOOD  147 

mentioned  later,  should  nourish  her  child  solely 
from  her  breast  up  to  the  age  of  eight  months,  and 
partially  to  the  end  of  the  first  year,  or,  failing  in 
either  limit,  as  long  as  possible. 

The  infant  should  be  put  to  the  breast  as  soon  as 
the  mother  has  recovered  somewhat  from  the  fatigue 
of  labor — some  four  or  eight  hours  after  birth.  Of 
course  no  milk  can  be  drawn  at  this  early  date,  but 
the  baby  gets  a  small  quantity  of  thin,  watery  fluid, 
called  colostrum,  which  affords  sufficient  nourish- 
ment, and  at  the  same  time,  from  its  laxative  prop- 
erties, clears  away  the  greenish  or  black  viscid 
material  that  collects  in  the  infant's  intestinal  canal 
during  intra-uterine  life.  This  procedure,  too,  is  of 
great  advantage  to  the  mother,  for  it  insures  proper 
contraction  of  the  womb,  draws  out  the  nipples,  and 
encourages  the  formation  of  milk. 

As  the  secretion  of  milk  is  never  fully  established 
until  the  third  day  after  labor,  it  stands  to  reason 
that  no  food  other  than  the  colostrum  is  required 
before  that  time.  Hence,  the  practice  of  filling  the 
infant's  stomach  with  gruel,  sugar  and  water,  and 
other  sweetened  mixtures,  is  more  than  useless,  for 
it  diminishes  the  activity  of  sucking  and  the  conse- 
quent stimulation  of  milk  production.  Put  the 
child  to  the  breast  every  two  hours  while  the  mother 
is  awake,  and  there  need  be  no  fear  of  starvation. 

After  the  third  day,  should  the  breast  not  yield 


148  HYGIENE   OF   THE  NURSERY 

a  supply  of  milk,  a  mixture  of  cream,  two  teaspoon- 
fuls,  whey  and  water  each  three  teaspoonfuls,  and 
one-fourth  of  a  teaspoonful  of  sugar  of  milk,  may 
be  given  every  fourth  hour,  the  baby  being  put 
to  the  breast  in  the  meanwhile.  When  the  flow 
begins,  however,  the  artificial  feeding  is  to  be  dis- 
continued. 

Usually  on  the  fourth  day  milk  is  secreted  and 
regular  lactation  commences.  Many  untrained 
mothers  make  a  failure  of  nursing  because  they 
know  nothing  of  the  manner  of  giving  suck;  of  the 
length  of  time  the  child  should  be  kept  at  the  breast; 
of  the  proper  time  for  and  interval  between  feed- 
ing, and  the  importance  of  regularity.  Upon 
these  points  the  physician  should  give  minute  in- 
structions. 

When  giving  the  breast,  the  infant  must  be  held 
partly  on  its  side,  on  the  right  or  left  arm,  accord- 
ing to  the  gland  about  to  be  drawn  from,  while  the 
mother  must  bend  her  body  forward,  so  that  the 
nipple  may  fall  easily  into  the  child's  mouth,  and 
steady  the  breast  with  the  first  and  second  finger  of 
the  disengaged  hand,  placed  above  and  below  the 
nipple.  In  case  the  milk  runs  too  freely — a  condi- 
tion very  apt  to  excite  vomiting — the  flow  is  easily 
regulated  by  gentle  pressure  with  the  supporting 
fingers.  Each  of  the  breasts  should  be  drawn  alter- 
nately, the  contents  of  one  being  usually  sufficient 


FOOD  149 

for  a  meal;  and  a  healthy  child  may  be  allowed  to 
nurse  for  fifteen  minutes  or  until  satisfied,  when  he 
will  stop  of  his  own  accord,  drop  the  nipple  and  fall 
asleep  with  milk  still  flowing  over  his  lips. 

During  the  first  six  weeks  the  breast  is  required 
every  second  hour,  from  6  A.  M.  until  10  p.  M.  At 
night  the  infant  should  be  put  in  a  crib  by  the 
mother's  bed,  or  in  an  adjoining  room,  under  the 
care  of  a  competent  nurse,  and  there  remain  quietly 
until  the  morning  feeding.  This  secures  the  mother 
eight  hours  of  uninterrupted  repose,  a  matter  of  great 
importance  to  her  general  health  and  consequent 
capacity  for  prolonged  lactation.  As  to  the  infant, 
he  may  rebel  at  first,  and  wake  and  cry,  so  that  it  is 
necessary  to  quiet  him  with  a  little  milk  and  water 
administered  from  a  bottle;  but  often,  after  a  few 
days  and  certainly  at  the  end  of  a  week  or  two,  the 
good  custom  of  sleeping  at  night  is  formed,  and 
there  is  no  further  trouble. 

Regularity  in  meal  hours  is  even  of  more  impor- 
tance in  early  than  in  adult  life,  on  account  of  the 
natural  feebleness  of  digestion,  and,  further,  regular 
nursing  has  a  marked  influence  upon  the  maternal 
food  supply,  for  it  is  a  fact  that  breasts  which  are 
emptied  at  fixed  intervals  produce  more  and  better 
milk,  than  those  called  upon  irregularly  and  too 
frequently.  To  secure  regularity,  it  is  only  neces- 
sary to  have  a  little  perseverance,  for  infants  are 


150  HYGIENE   OF   THE   NURSERY 

such  creatures  of  habit  that  a  short  training  brings 
them  into  the  way  of  expecting  food  only  at  cer- 
tain times,  and,  when  healthy,  they  wake  to  suck 
the  breast  with  almost  the  precision  of  the  clock. 
While  insisting  upon  this  rule,  one  must  recognize 
the  fact  that,  although  in  the  vast  majority  of 
instances  a  two-hours'  interval  is  most  suitable 
up  to  the  second  month,  there  is  no  absolute  law  as 
to  the  number  of  daily  nursings.  Some  infants 
seem  to  need  food  less  frequently,  and  it  is  best  to 
respect  their  peculiarity  and  not  force  the  breast 
upon  them  so  long  as  they  sleep  well,  do  not  fret 
when  awake,  and  thrive  generally.  Others,  again, 
may  require  it  oftener,  every  hour  and  a  half,  per- 
haps, and  once  or  twice  at  night.  In  these  excep- 
tional cases  an  appropriate  schedule  can  only  be 
made  by  close  observation  of  individual  character- 
istics. 

A  common  and  most  ruinous  mistake  is  to  resort 
to  constant  feeding  as  a  means  of  pacifying  crying. 
Babies  certainly  do  cry  from  hunger,  but  just  as 
frequently  the  crying  results  from  colic,  or  from  the 
discomfort  and  pain  of  indigestion.  Every  mother 
should  be  able  to  recognize  the  difference.  The  cry 
from  hunger  usually  begins  after  a  sound  sleep.  It 
is  not  peevish,  and  stops  at  the  sight  of  the  breast, 
when  the  infant  rouses  himself,  presents  an  expres- 
sion of  pleasure,  clinches  his  hands  and  flexes  his 


FOOD  151 

limbs.  The  cry  of  colic  is  violent  and  paroxysmal; 
the  face  is  livid  and  wears  an  expression  of  suffer- 
ing; the  abdomen  is  distended  and  hard;  the 
hands  and  feet  are  cold;  the  legs  are  drawn  up  or 
kicked  violently  about ;  and  an  explosion  of  wind  from 
the  mouth  or  bowels  ends  the  attack.  A  peevish 
cry,  hot  skin  and  sour  breath  attend  indigestion. 

It  stands  without  saying  that  the  cry  of  hunger 
must  be  relieved  by  giving  food;  but  this  is  the 
very  worst  thing  to  do  under  other  circumstances, 
for  it  both  breaks  up  good  habits  and  produces 
serious  mischief.  The  pain  of  colic  and  the  discom- 
fort of  indigestion  are  chiefly  due  to  the  accumula- 
tion of  flatus  resulting  from  the  fermentation  of 
food.  Mothers  soon  learn,  and  unfortunately 
infants  too,  that  the  breast  milk  temporarily  relieves 
suffering.  This  it  does  in  the  same  way  as  any  other 
warm  liquid;  but,  unlike  a  simple  fluid,  milk  only 
adds  more  material  to  the  already  fermenting  con- 
tents of  the  gastro-intestinal  canal,  and  every  nurs- 
ing is  soon  followed  by  more  pain,  until  between  cry- 
ing and  sucking  and  sucking  and  crying,  the  infant's 
life  is  passed  in  misery,  if  not  cut  short  altogether. 
Instead  of  continuous  feeding,  the  plan  for  relief  is 
to  decrease  the  quantity  of  food  by  increasing  the 
intervals  between  nursing  and  by  abridging  the  time 
of  lying  at  the  breast. 

After  the  sixth  week  the  interval  between  nurs- 


152  HYGIENE   OF   THE   NURSERY 

ings  may  be  slowly  increased  until,  by  the  fourth 
month,  it  reaches  three  hours.  During  this  period, 
also,  the  time  of  lying  at  the  breast  may  be  gradu- 
ally lengthened  to  twenty  minutes,  for  the  quantity 
of  milk  secreted  and  the  child's  appetite  and  capacity 
for  food  are  all  augmented  as  the  days  pass  by.  At 
the  end  of  the  sixth  month,  feeding  every  fourth 
hour  suits  some  children  well,  but  as  a  rule  the 
three-hour  interval  must  be  adhered  to  from  the 
fourth  month  to  the  end  of  lactation. 

Many  authorities  recommend  additional  artificial 
feeding,  alternating  with  nursing,  after  the  sixth  or 
eighth  month.  This  plan  of  mixed  feeding  is 
perfectly  proper,  if  the  baby  ceases  to  gain  strength 
and  flesh  while  on  the  breast.  If  otherwise,  the 
maxim  of  not  interfering  with  any  course  that  is 
doing  well  is  as  applicable  here  as  elsewhere,  and 
the  breast  may  be  relied  upon  entirely  until  the 
time  comes  for  weaning.  Should  additional  nutri- 
ment be  required,  the  food  must  be  selected  with 
due  reference  to  age  and  prepared  in  the  same 
manner  as  in  regular  bottle-feeding,  and  employed 
only  to  supplement  the  breast  milk,  which  must  be 
conserved  as  long  as  possible,  since  even  a  little 
natural  food  is  of  great  value  in  insuring  proper 
growth  and  development  during  the  earlier  months 
of  life. 

It  is  a  good  plan,  however,  even  when  breast- 


FOOD  153 

feeding  is  progressing  satisfactorily  to  begin,  about 
the  fifth  month,  to  substitute  one  nursing  daily  by  a 
bottle;  this  allows  the  mother  more  freedom  for 
rest  and  recreation,  and,  at  the  same  time,  accus- 
toms the  infant  to  being  artificially  fed,  and  in- 
creases the  ease  of  weaning  when  this  becomes 
necessary.  Another  means  of  facilitating  the 
substitution  of  the  bottle  for  the  breast  is  to  begin 
early  to  use  it  in  giving  the  drinking  water,  which 
every  baby  requires  three  or  four  times  daily. 

The  date  of  weaning  cannot  be  fixed  for  all  cases, 
since  it  must  depend  upon  two  conditions — the 
health  of  the  mother  and  the  development  of  the 
child.  When  the  former  continues  to  be  robust 
and  the  child  steadily  grows  and  gains  flesh,  lacta- 
tion can  be  prolonged  until  the  tenth  month. 
Usually  if  persevered  in  longer,  the  mother's 
strength  begins  to  fail,  her  milk  is  lessened  in 
quantity  or  becomes  poor  in  quality,  the  child's 
nutrition  suffers,  and  he  grows  pale,  thin  and  flabby, 
and  may  develop  the  disease  known  as  rickets.  Not- 
withstanding the  age,  the  beginning  of  summer  is  a 
bad  time  to  wean  an  infant,  and  unless  the  indi- 
cations for  withdrawing  the  breast  are  very  urgent, 
it  is  better  to  postpone  the  change  until  the  hot 
months  have  passed,  resorting,  in  the  meantime,  to 
artificial  feeding  as  a  supplement  to  any  deficiency 
in  the  maternal  supply. 


154  HYGIENE   OF   THE   NURSERY 

Change  in  the  manner  of  feeding  may  be  accom- 
plished gradually  or  suddenly.  In  gradual  wean- 
ing, about  four  weeks  are  required  to  prepare  for 
the  absolute  withdrawal  of  the  breast.  For  instance, 
if  suck  be  given  every  three  hours,  or  six  times  a 
day,  there  should  be,  during  the  first  week  of  prepa- 
ration, one  artificial  feeding  and  five  nursings  daily; 
during  the  second,  two  and  four;  during  the  third, 
four  and  two;  during  the  fourth,  five  and  one. 
Then  the  breast  must  be  entirely  withheld.  Care- 
fully prepared  milk-food,  administered  from  a 
bottle,  is  the  best  substitute.  At  the  age  of  ten 
months  a  mixture  that  ordinarily  agrees  well  is: 

1$.     Cream i  tablespoonful    (fld.  oz.  J). 

Milk 8  tablespoonfuls  (fld.  oz.  4  ). 

Sugar  of  milk i  teaspoonful. 

Water 3  tablespoonfuls  (fld.  oz.  i£). 

This  is  to  be  poured  into  a  perfectly  clean  bottle, 
warmed  in  a  water-bath,  and  taken  through  a  clean, 
plain  rubber  tip.  Should  the  quantity  (six  fluid- 
ounces*)  be  insufficient  to  satisfy  the  child's  appe- 
tite, the  milk  and  water  may  be  increased  until  the 
mixture  measures  eight  fluidounces. 

When  such  accidents  as  fever  or  disordered  diges- 
tion, with  vomiting  and  diarrhoea,  occur  during  the 
period  of  preparation,  the  number  of  artificial 

*  One  fluidounce  =  two  tablespoonfuls. 
One  fluidrachm  =  one  teaspoonful. 


FOOD  155 

feedings  must  be  reduced,  or  the  breast  resumed 
until  the  disturbance  be  passed;  then  the  course 
may  be  begun  again  and  carried  to  its  completion. 

Usually  there  is  little  trouble  in  weaning  infants 
in  this  way.  Sometimes  they  become  fretful  under 
the  change  and  may  refuse  food  entirely  for  a  day 
or  more;  but  a  little  determination  on  the  part  of 
the  mother  and  the  cravings  of  hunger  will  soon 
overcome  this  difficulty. 

Occasionally  the  child  refuses  to  suck  milk  from 
a  bottle  or  to  drink  it  from  a  cup  or  spoon — in  fact 
seems  to  object  to  any  form  of  liquid  food  except 
that  drawn  from  the  mother — while  at  the  same 
time  he  is  eager  for  bread  or  other  solid  food. 
Under  these  circumstances  prepare  for  each  meal  a 
moderate  portion  of  either  rice  pudding  or  junket. 
After  these  have  been  taken  for  a  day  or  two,  add 
to  each  meal  a  little  milk,  reducing  the  amount  of 
pudding  or  junket;  stir  the  whole  together  and 
feed  from  a  spoon;  next  day  still  further  reduce  the 
solid  and  increase  the  liquid,  and  so  proceed  until 
finally  a  taste  for  milk  is  cultivated. 

Sudden  weaning  is  not  advisable  unless,  while 
the  breast  is  being  presented,  there  is  an  absolute 
refusal  to  take  artificial  food  from  either  a  bottle  or 
a  spoon.  This  is  most  apt  to  occur  when  food  has 
been  given  too  frequently,  and  when  the  breast  has 
been  used  as  a  means  to  quiet  crying.  The  plan  is 


156  HYGIENE   OF   THE   NURSERY 

also  to  be  recommended  when  the  mother's  health 
becomes  so  affected  as  to  render  any  further  suck- 
ling a  positive  peril  to  the  child's  life;  attacks  of 
erysipelas  or  of  small-pox  are  instances  in  point. 

The  physician  is  often  forced  to  decide  upon  the 
advisability  of  premature  weaning.  His  decision 
must  be  made  cautiously  and  after  thorough  in- 
vestigation of  two  propositions,  namely:  a,  the 
effect  of  further  lactation  upon  the  health  of  the 
mother,  and  b,  the  requirements  of  the  child. 

a.  Lactation  being  a  physiological  process  is  not 
a  drain  upon  the  systemic  strength  so  long  as  the 
functions  of  nutrition  are  actively  performed,  but 
under  other  circumstances  it  very  frequently  be- 
comes so.  A  mother  must  make  no  attempt  to 
nurse  if  she  has  tuberculosis,  advanced  cardiac  or 
active  kidney  disease,  hysteria,  epilepsy,  marked 
anaemia,  cancer,  goiter,  or  is  septic  or  convulsed  after 
child-birth.  Premature  weaning  is  necessary  when 
the  mother  is  attacked  by  a  contagious  disease  or  by 
any  acute  disease  threatening  dangerous  temporary 
prostration,  such  as  typhoid  fever.  Ordinarily, 
however,  the  general  condition  that  leads  to  with- 
drawal of  the  breast  is  one  of  simple  loss  of  strength 
and  flesh  on  the  part  of  the  mother.  Undoubtedly 
these  indications  often  warrant  the  procedure,  but 
every  one  who  has  seen  much  of  children's  practice 
must  have  met  with  many  cases  in  which  the  advice 


FOOD  157 

to  wean  has  been  given  carelessly  and  unnecessarily, 
and  in  which  the  child  might  have  had  its  natural 
food  had  proper  attention  been  given  to  the  health 
of  the  mother. 

If  a  woman  be  worn  out  by  household  cares;  if 
she  wear  herself  out  by  a  round  of  dinners,  balls  or 
shopping,  or  if  she  expose  herself  to  injurious  at- 
mospheric conditions  and  eat  improper  food,  she 
grows  weak  and  thin  whether  she  be  nursing  or 
not;  and  a  woman  heedless  of  her  health  will  prob- 
ably care  little  whether  she  suckles  her  child  or 
gives  it  up  to  a  wet-nurse  or  to  the  bottle. 

In  addition  to  making  nursing  the  important  duty 
of  her  life  for  the  time  being,  a  mother  must  be  as 
free  from  household  cares  as  possible.  Mental  and 
physical  fatigue  must  be  avoided,  sufficient  exercise 
must  be  taken  to  maintain  a  healthy  appetite  and 
digestion,  abundant  time  devoted  to  rest  and  sleep, 
and  regular  evacuations  of  the  bowels  secured. 
As  to  diet,  the  nursing  mother  requires  a  plentiful 
supply  of  fluids  and  of  plain  and  easily  digestible 
food,  with  a  judicious  portion  of  meat,  vegetables, 
and  fruit.  She  should  eat  three  regular  meals 
daily,  with  a  cup  of  milk,  cocoa  or  gruel  at  early 
bed-time,  and  in  some  cases  between  meals.  She 
may  be  allowed  eggs,  plainly  cooked;  cereals  and 
nearly  all  soups  and  vegetables;  sweet  fruits,  and 
meat,  usually  once  and  never  more  than  twice  a 


158  HYGIENE    OF   THE   NURSERY 

day;  but  must  avoid  acid  fruits,  salads,  pastry  and 
rich  desserts;  tea  and  coffee,  except  in  extreme 
moderation,  and  wine  or  beer  absolutely. 

Should  the  secretion  of  milk  be  scanty,  it  may 
often  be  increased  by  the  free  use  of  animal  broths, 
chocolate,  gruel,  or  milk,  and  sometimes  the  em- 
ployment of  a  good  malt  extract  may  be  necessary. 
Such  tonics  as  ferrated  elixir  of  cinchona,  bitter 
wine  of  iron,  and  the  preparation  known  as  "beef, 
wine  and  iron,"  are  useful  when  there  is  anae- 
mia, or  when  the  general  failure  of  strength  can- 
not be  overcome  by  food  and  attention  to  hygienic 
rules. 

The  ordinary  local  conditions  indicating  the 
necessity  of  premature  weaning,  on  the  mother's 
account,  are  fissures  of  the  nipple,  and  mammary 
abscess. 

Fissure  being  usually  a  unilateral  condition,  it 
is  only  necessary  to  retire  the  affected  side  from 
duty  and  nourish  the  child  alternately  from  the 
unaffected  gland  and  from  the  bottle  until  healing 
takes  place,  the  disabled  breast  being  pumped  or 
massaged  in  the  meantime  to  keep  up  secretory 
activity.  Should  both  sides  be  affected,  weaning  may 
be  imperative,  on  account  of  the  extreme  pain  pro- 
duced by  sucking,  although,  even  under  these 
circumstances,  an  effort  must  be  made  to  maintain 
the  flow  of  milk  by  regular  pumping.  Sometimes 


FOOD  159 

women  are  able  to  struggle  through  the  attack 
by  taking  advantage  of  the  relief  and  protection 
afforded  by  a  nipple-shield. 

Fissures  of  the  nipple  may  be  preceded  by  vari- 
ous diseases  of  the  delicate  skin  of  the  part.  They 
result,  also,  from  want  of  cleanliness  or  from  keep- 
ing the  nipple  too  moist,  and  when  constant  sucking 
is  allowed  or  when  there  is  a  continual  flow  of  milk. 
They  may  be  prevented  by  proper  attention  to 
the  nipple  before  confinement.  During  the  latter 
months  of  pregnancy  the  clothing  covering  the 
breast  must  be  loose,  and  the  wearing  of  a  wire  tea- 
strainer  over  the  nipple  to  prevent  pressure  has 
been  recommended  by  one  authority.  Each  day, 
for  three  months  before  labor,  the  nipples  should 
be  washed  thoroughly  with  hot  water  in  the  even- 
ing and  anointed  with  cocoa-butter  in  the  morn- 
ing. At  the  same  time,  should  the  nipples  be 
small  or  retracted,  the  woman  must  be  taught  to 
use  her  thumb  and  finger  to  draw  them  out.  This 
process  is  not  only  an  advantage  in  giving  proper 
size  and  shape,  but  brings  the  skin  into  good  con- 
dition without  hardening  it.  The  application  of 
alcoholic  and  astringent  lotions  is  not  to  be  recom- 
mended. They  tend  to  harden  the  tissue,  which 
should  be  soft  and  pliable  rather  than  tanned,  and 
render  the  nipples  liable  to  crack. 

When  a  fissure  exists,  it  is  best  first  to  see  whether 


l6o  HYGIENE    OF   THE   NURSERY 

or  not  nursing  can  be  continued  by  means  of  a 
nipple-shield.  Should  the  child  refuse  this,  a  good 
plan  is  to  fill  the  shield  with  warm  milk  and  invert 
it  over  the  nipple.  The  infant  then  draws  the  fluid 
at  once  and  without  difficulty,  and  will  often  con- 
tinue sucking  until  the  breast  milk  follows.  After 
nursing  and  removing  the  shield,  the  nipple  must 
be  dried  thoroughly  with  absorbent  cotton,  and  the 
following  lotion  applied  with  a  camel's-hair  brush : 

Take  of— 

Boracic  acid 20  grains. 

Mucilage  of   acacia i  fluidounce.     Mix. 

Mammary  abscess  requires  careful  surgical 
attention. 

b.  On  the  part  of  the  infant,  there  are  several  in- 
dications for  anticipating  the  time  of  withdrawing 
the  mother's  breast,  but  this  is  always  a  serious 
matter  and  must  never  be  advised  without  most 
careful  consideration. 

The  occurrence  of  pregnancy  during  lactation 
necessitates  immediate  weaning,  but  this  is  by  no 
means  the  case  with  the  re-establishment  of  men- 
struation. Usually  the  function  of  the  breasts  stops 
on  the  return  of  the  monthly  flow,  and  sometimes, 
while  secretion  continues,  the  milk  is  so  altered  in 
quality  as  to  be  unfit  for  food;  but,  at  others,  though 
the  quantity  may  be  diminished,  the  quality  is 
unchanged  and  the  infant  keeps  well  and  gains 


FOOD  l6l 

steadily  between  the  periods.  Under  these  con- 
ditions the  baby  should  be  kept  at  the  breast, 
though  it  may  be  advisable,  during  the  first  day 
or  two  of  menstruation,  to  feed  partially  or  entirely 
from  a  bottle.  Premature  weaning  is  also  necessary 
if  the  mother  contracts  a  dangerous  contagious 
disease,  as  small-pox,  scarlet  fever,  or  erysipelas; 
if  the  mammary  glands  become  inflamed;  if  the 
breast  does  not  afford  sufficient  nourishment  and 
artificial  food  be  refused;  and,  finally,  if  dentition 
be  markedly  delayed  and  the  premonitory  symptoms 
of  rickets  appear.  As  to  the  amount  of  nourish- 
ment, it  must  be  remembered  that  the  breast 
milk  may  be  of  good  quality,  but  so  diminished  in 
quantity  that  it  is  insufficient;  or,  while  abundant 
in  quantity,  so  poor  in  quality  that  it  does  not  meet 
the  demands  of  nutrition.  Even  without  a  minute 
examination  of  the  milk,  it  is  possible  to  form  a 
good  idea  of  which  condition  is  present  from  the 
behavior  of  the  infant  in  the  act  of  sucking.  If 
the  milk  be  good  in  quality  but  deficient  in  quantity, 
the  baby,  when  put  to  the  breast,  seizes  the  nipple 
as  if  famished  and  draws  upon  it  vigorously  for 
a  time,  and  then  drops  it  with  a  scream  of  rage. 
On  the  contrary,  should  there  be  an  abundant 
supply  of  poor  milk,  the  nipple  is  grasped  languidly, 
the  child  lies  a  long  time  at  the  breast  and  falls 
asleep  there.  Consideration  of  the  final  indication 


1 62  HYGIENE    OF   THE   NURSERY 

opens  the  question  of  the  propriety  of  regulating 
weaning  by  the  progress  of  dentition.  This  is 
certainly  a  good  guide,  but  not  in  the  way  im- 
plied in  the  old  precept,  that  the  child  must  not 
be  taken  from  the  breast  until  evolution  of  the 
stomach  and  eye  teeth.  Insufficient  food  is  one  of 
the  chief  causes  of  rickets,  and  rickets  more  than 
any  other  disease  delays  dentition;  consequently, 
should  the  teeth  not  pierce  the  gum  in  time,  the 
inference  is  for  other  food  rather  than  a  continuance 
of  the  faulty  maternal  supply.  In  this  connection 
one  must  remember  what  has  already  been  stated 
in  regard  to  " mixed  feeding,"  and  if  the  breast 
secretes  only  enough  milk  of  good  quality  to  serve 
for  two  or  three  daily  feedings,  even  so  little  must 
be  carefully  conserved  during  the  earlier  months  of 
life  and  the  deficiency  made  up  by  a  properly  modi- 
fied cow's  milk  mixture  administered  from  a  bottle. 
When  the  mother's  milk  so  disagrees  as  to  war- 
rant withdrawal  of  the  breast,  the  baby  does  not 
thrive,  ceases  to  gain  weight  or  loses  steadily, 
and  presents  the  evidences  of  disordered  digestion. 
It  may  vomit  or  eructate,  though  the  symptoms 
being,  as  a  rule,  intestinal  rather  than  gastric, 
there  are,  usually,  discomfort,  constant  crying, 
poor  and  restless  sleep,  distention  of  the  abdomen, 
colic,  frequent  expulsion  of  flatus  from  the  bowel, 
sometimes  constipation  but  usually  diarrhoea,  with 


FOOD  163 

loose  green  evacuations  containing  mucus  and 
passed  with  much  gas. 

Habitual  vomiting  does  not  necessarily  indicate 
weaning.  In  such  cases  an  effort  must  be  made 
to  overcome  the  trouble  before  resorting  to  extreme 
measures.  If  vomiting  occurs  soon  after  jiursing, 
it  may  simply  mean  that  the  infant  has  taken  too 
much  food,  therefore,  shorten  the  time  of  lying  at 
the  breast,  give  one  breast  only,  and  interrupt  the 
sucking  by  short  periods  of  rest,  thus  preventing 
too  rapid  feeding.  Vomiting  taking  place  some- 
time after  nursing  and  repeated,  is  often  due  to 
the  milk  being  too  rich  in  fat,  and  may  be  overcome 
by  increasing  the  intervals  between  nursings,  or 
by  giving,  from  a  feeding  bottle,  immediately 
before  each  meal  one  or  two  tablespoonfuls  of 
pure  boiled  water,  lime-water  and  water,  or  barley- 
water.  When  there  is  constant  colic  the  milk  is  too 
rich  in  proteids,  and  the  mother  should  take  more 
exercise  in  the  fresh  air,  eat  less  meat,  avoid  worry 
and  control  her  emotions.  The  element  of  constipa- 
tion associated  with  colic  can  be  but  little  influenced 
through  the  mother's  milk. 

Where  all  expedients  fail  and  one  is  reasonably 
sure  that  the  only  proper  course  is  to  anticipate 
the  time  of  weaning,  the  next  point  to  consider  is 
whether  the  infant  shall  be  brought  up  by  hand  or 
by  a  wet-nurse. 


164  HYGIENE   OF  THE  NURSERY 

2.  Feeding  by  a  wet-nurse. — The  advantage  of 
feeding  from  the  breast  of  a  wet-nurse  is  that  the 
mother's  milk  is  substituted  by  the  milk  of  another 
woman;  in  other  words,  that  natural  feeding  is  con- 
tinued— a  matter  of  moment  in  all  cases,  and  of  in- 
estimable importance  with  delicate  children.  The 
disadvantage  consists  in  the  difficulty  of  finding,  in 
a  woman  belonging  to  the  class  from  which  wet- 
nurses  come,  all  the  moral  and  physical  characters 
essential  to  a  good  substitute,  and  the  fact  that  a 
stranger  is  introduced  into  the  household,  often  to 
deceive  and  annoy  the  family,  and  on  the  slightest 
provocation  to  leave  her  charge  to  fate  or  to  the 
tender  mercies  of  another  of  her  kind.  For  these 
reasons  it  is  preferable,  in  the  majority  of  instances, 
to  trust  to  careful  bottle-feeding.  Nevertheless,  as 
some  children  must  have  human  milk  if  their  lives 
are  to  be  saved,  the  rules  for  selecting  a  wet-nurse 
must  be  understood. 

The  woman  chosen  must  be  strong  and  robust, 
but  rather  spare  than  fat.  Her  bill  of  health  must 
be  perfectly  free  from  hereditary  tendency  to  men- 
tal or  physical  disease  and  from  taint  of  syphilis  or 
tuberculosis.  She  must  be  cheerful,  good-natured, 
active,  careful,  and  temperate  in  habits.  Her  age 
should  be  between  twenty  and  thirty  years;  she 
should  understand  the  care  of  an  infant  and  the 
manner  of  giving  suck;  her  child  ought  to  be  of 


FOOD  165 

nearly  the  same  age  as  the  infant  to  be  adopted, 
and  she  must  be  able  to  afford  an  abundant  supply 
of  good  milk. 

The  last  quality  can  be  estimated  by  inspecting 
the  breast,  by  examining  some  of  the  milk  drawn 
by  a  pump,  and  by  ascertaining  the  condition  of  the 
woman's  own  child.  The  breasts  of  a  good  nurse 
are  not  necessarily  large,  but  are  firm  to  the  touch 
and  pyriform  in  shape,  with  well  developed,  promi- 
nent nipples,  and  with  the  skin  distinctly  marbled 
with  large  blue  veins.  The  milk,  which  ought  to 
flow  readily  on  pressure  or  on  suction,  should  be 
opaque  and  dull  white  in  color,  have  a  specific 
gravity  of  1.031,  an  alkaline  reaction,  show,  when 
placed  under  the  microscope,  a  number  of  minute, 
equal-sized,  fat  globules,  and  yield  on  analysis  a 
normal  percentage  of  fat,  proteids  and  sugar.  Its 
quantity  may  be  ascertained  by  weighing  the  child 
before  and  after  sucking,  the  normal  gain  being 
from  three  to  six  ounces.  There  is,  however,  no 
better  or  more  readily  applied  test  of  the  quality 
of  a  nurse  than  the  size,  weight,  and  general  devel- 
opment of  her  own  child;  and  if  it  be  weak  and  ill- 
nourished,  no  amount  of  fitness  in  other  respects 
can  warrant  her  engagement. 

Even  when  a  woman  is  found  fulfilling  in  her 
single  person  all  the  required  conditions — a  rare 
thing,  indeed — it  does  not  necessarily  follow  that 


1 66  HYGIENE    OF   THE   NURSERY 

her  milk  will  suit  the  baby  to  be  suckled.  Then 
changes  and  new  trials  must  be  made  until  the 
desired  end  be  attained. 

The  diet  of  a  wet-nurse  and  the  manner  of  wean- 
ing must  be  governed  by  the  rules  already  given  for 
maternal  feeding. 

Personally,  I  have  had  such  good  results  from 
carefully  regulated  bottle  feeding  that  I  have,  as 
far  as  possible,  given  up  the  emloyment  of  wet- 
nurses,  preferring  to  regulate  the  artificial  food 
myself  rather  than  allow  an  ignorant  woman  to 
supplement  surreptitiously  her  deficient  supply  of 
breast  milk  by  an  unskilfully  proportioned  food— 
an  event  of  not  uncommon  occurrence. 

3.  Artificial  feeding. — In  my  experience  there 
are  few  American  women,  especially  in  the  well-to- 
do  classes,  who  do  not  look  upon  the  duty  of  nursing 
their  babies  as  a  pleasant  one;  but  there  are  many 
who  are  completely  unable  to  do  so,  and  a  vast 
number  in  whom  the  secretion  of  milk  fails  after 
a  few  weeks  or  months  of  lactation.  They  must, 
therefore,  through  no  fault  of  their  own,  resort  to 
a  wet-nurse  or  to  artificial  feeding.  Usually  they 
select  the  last  method,  with  results  that  vary  in 
direct  proportion  to  the  care  and  intelligence  dis- 
played in  carrying  it  out. 

There  is  no  artificial  food  equal  to  the  milk  of  a 
robust  woman.  The  fluid,  however,  secreted  from 


FOOD  167 

the  glands  of  a  feeble  or  unhealthy  mother,  though 
often  sufficient  in  quantity  to  fill  the  suckling's 
stomach  and  satisfy  the  cravings  of  hunger,  does 
not  contain  enough  pabulum  to  meet  the  demands 
of  nutrition.  In  such  unfortunate  cases,  good 
cows'  milk,  properly  prepared,  is  a  better  food 
than  the  bad  breast  milk.  More  care  and  trouble, 
though,  are  involved  in  bottle-  than  in  breast- 
feeding. If  the  child  has  been  nourished  in  the 
natural  way — i.  e.,  breast-fed — even  for  a  few 
weeks,  or  when  the  powers  of  digestion  are  inher- 
ently active,  the  task  is  far  easier  to  accomplish. 
In  these  cases  the  stomach  and  intestinal  canal, 
inactive  in  foetal  life,  are  trained  to  their  new  duties 
under  normal  conditions,  and  so  prepared  for  the 
digestion  of  properly  selected  artificial  food.  On 
the  contrary,  if  digestion  be  naturally  feeble,  or  if 
the  infant  must  be  bottle-fed  from  the  first,  great 
difficulty  may  be  expected,  and  most  skilful  hand- 
ling is  necessary. 

To  insure  success  in  hand-feeding,  it  must  be 
remembered  that  an  infant  is  not  nourished  alone 
by  the  food  he  swallows,  but  by  that  portion  of  it  he 
digests  and  assimilates.  The  best  diet,  therefore, 
is  one  so  adapted  to  age  and  digestive  power  that 
everything  eaten  will  be  digested  and  absorbed. 
But  as  children  differ  as  much  in  constitution  as  in 
feature,  it  is  impossible  to  formulate  exactly  a  food 


1 68  HYGIENE    OF   THE   NURSERY 

that  will  be  applicable  to  every  case,  or  one  that 
needs  no  change  from  month  to  month  of  progress- 
ing growth.  As  age  and  strength  increase,  there 
is  a  corresponding  development  of  the  gastro-intes- 
tinal  functions  and  a  demand  for  more  and  stronger 
food.  On  the  other  hand,  should  the  system  be 
accidentally  reduced  by  disease,  the  digestion,  sym- 
pathizing in  the  general  debility,  temporarily  loses 
its  normal  activity  and  assumes  that  of  an  earlier 
age.  In  such  a  case  more  nourishment  is  certainly 
needed  to  build  up  the  failing  strength,  but  it  is  to 
be  supplied  by  giving  such  food  as  can  be  com- 
pletely assimilated,  and  not  by  forcing  down  strong 
food  merely  because  it  is  strong;  for  the  latter, 
when  not  vomited,  passes  through  the  bowels  un- 
digested, and  the  little  creature  starves  to  death  in 
the  midst  of  plenty,  or  dies  from  the  ill  effects  of 
the  constant  presence  of  fermenting  food  in  the  ali- 
mentary canal.  On  these  accounts  many  changes 
in  diet,  as  to  quality  and  quantity,  must  be  antici- 
pated and  made. 

Important  matters,  therefore,  to  be  studied  in 
detail  are:  a,  the  selection  of  a  proper  substitute  for 
the  breast  milk;  b,  the  quantity  to  be  given;  c,  the 
method  of  preparation;  d,  the  mode  of  administra- 
tion; and,  e,  the  means  of  preservation. 

a.  Healthy  breast  milk  must  be  taken  as  the 
type  of  infant's  food,  and  the  nearer  an  artificial 


FOOD  169 

substitute  can  be  made  to  approach  it  in  chemical 
composition  and  physical  properties,  the  more 
perfect  it  is. 

Normal  breast  milk  has  a  specific  gravity  of  1.031. 
It  is  a  persistently  alkaline  fluid,  having  a  some- 
what animal,  usually  disagreeable,  and  very  rarely 
sweetish  taste.  It  is  bluish- white  in  color,  thin  and 
watery  in  consistence,  and  contains  no  bacteria. 

According  to  recent  analyses,  its  average  com- 
position is: 

Fat 4.00  per  cent. 

Milk  sugar  (lactose) 7 .00  per  cent. 

Proteids i .  50  per  cent. 

Salts o .  20  per  cent. 

Water 87 .30  per  cent. 

Some  authorities  give  a  higher  albuminoid  average,  namely,  2  per 
cent.;  but,  as  will  be  detailed  later,  the  proportion  of  this  ingre- 
dient varies  greatly,  and  it  is  safe  to  assert  that  a  range  from 
i. oo  to  2.25  per  cent,  is  perfectly  normal. 

Human  milk  contains,  then,  fat,  nitrogenous 
material,  sugar,  salts  and  water — all  the  elements 
essential  to  repair  tissue  waste,  to  supply  new 
material  for  growth,  and  to  maintain  body  heat,  or, 
in  other  words,  to  constitute  a  perfect  aliment; 
and  these,  too,  are  so  proportioned  in  the  combi- 
nation as  to  most  easily  and  completely  meet  the 
demands. 

It   must   not  be   supposed,   however,   that   the 


1 70  HYGIENE    OF   THE   NURSERY 

elements  are  uniformly  present  in  the  same  pro- 
portion. On  the  contrary,  the  fluid  varies  both 
at  different  periods  of  lactation  and  in  different 
individuals. 

This  fact  is  the  most  striking  feature  of  Professor 
Leeds'  experimental  work,  which  shows  that  the 
most  changeable  constituent  is  the  proteids,  vary- 
ing from  a  maximum  of  4.86  per  cent,  to  a  minimum 
of  0.85;  the  next  are  the  fat  and  salts,  the  maximum 
being  about  three  times  the  minimum,  and  the  least 
the  sugar.  The  latter,  in  fact,  varies  but  little  from 
a  standard  of  about  7  per  cent.  The  function  of 
the  proteids  is  nutritive,  that  of  milk  sugar  calori- 
facient;  hence,  the  point  seems  to  be  that  nature, 
while  allowing  a  wide  range  of  oscillation  in  the 
rapidity  of  tissue  building,  carefully  provides  an 
available  fuel  for  the  constant  maintenance  of  animal 
heat — the  supply  of  caloric  due  to  cerebral  impulses 
and  self-originated  locomotion  being  extremely 
small  in  early  infancy. 

In  seeking  a  substitute  for  human  milk,  one  natur- 
ally turns  to  the  domestic  animals  for  the  source  of 
supply.  Between  the  milk  of  the  ass,  cow,  goat  and 
ewe  there  is  little  choice,  so  far  as  composition  is 
concerned,  although,  perhaps,  asses'  milk  resembles 
that  of  women  a  little  more  closely  than  the  others; 
nevertheless,  cows'  milk  is  usually  selected,  because, 
being  plentiful,  it  is  easily  obtained  and  cheap. 


FOOD  171 

Cows'  milk*  (market  milk)  has  a  specific  gravity 
of  1.027  to  1.035,  is  richer  looking,  that  is,  whiter 
and  more  opaque  than  human  milk,  is  slightly  acid 
in  reaction  unless  perfectly  fresh  from  pasture-fed 
animals,  when  it  may  be  neutral  or  alkaline,  and 
always  contains  bacteria.  It  has  the  following 
average  composition: 

Fat 4.0  per  cent. 

Milk  sugar 5  -o  per  cent. 

Proteids 3.5  per  cent. 

Salts 0.7  per  cent. 

Water 87  .o  per  cent. 

*  The  character  of  cows'  milk  may  be  determined  with  sufficient 
accuracy  in  the  following  way: 

Provide  a  specific  gravity  glass,  such  as  is  shown  in  Fig.  18, 
and  which  can  be  obtained  at  any  chemist's,  or  a  lactometer  may 
be  used.  To  obtain  the  specific  gravity,  fill  a  beaker  to  such  a 
point  with  milk  that  it  will  float  the  specific  gravity  glass  or 
lactometer,  and  read  the  degree  of  density  from  the  scale  at  a 
level  with  the  surface  of  the  milk.  The  chemical  reaction  is 
found  by  inserting  a  piece  of  blue  litmus  paper,  which  should 
turn  slightly  red  a  few  moments  after  being  wet.  In  applying 
this  test  small  pieces  of  litmus  paper  should  be  examined  under 
and  in  the  milk,  as  exposure  to  air  may  redden  paper  dipped  in 
milk,  although  the  fluid  itself  may  not  be  acid.  To  ascertain  the 
proportion  of  cream,  cut  a  narrow  strip  of  paper  four  inches 
long,  and  divide  the  upper  half-inch,  by  cross-markings,  into 
twelve  equal  parts;  paste  this  on  a  beaker  (Fig.  18)  with  the 
marked  portion  uppermost,  and  the  lower  edge  coming  accurately 
to  the  bottom  of  the  beaker;  then  pour  in  enough  milk  to  come 
just  to  the  top  of  the  paper,  and  place  the  whole  aside  for  twenty- 
four  hours.  During  this  time  the  cream  rises  and  appears  as 


172 


HYGIENE   OF   THE   NURSERY 


Comparing  -this  analysis  with  that  previously 
given  for  human  milk,  it  is  readily  seen  that  the 
two  fluids  differ  in  specific  gravity  and  reaction,  and 
that  cow's  milk  contains  more  nitrogenous  material 
but  much  less  sugar  than  woman's 
milk. 

While  the  sugar  of  human  and 
cows'  milk  is  chemically  identical, 
and  the  fats  are  quite  similar,  there 
are  important  differences  in  the 
quality  as  well  as  the  quantity  of 
the  nitrogenous  material.  This  in 
both  fluids  is  complex,  being  made 
up  of  casein,  lactalbumin,  and 
peptones.  The  peptones  are  pres- 
ent in  very  small  quantities  only, 
and  to  what  extent  they  exist 
naturally,  and  to  what,  in  cows' 
milk,  they  are  formed  by  bacterial 
action,  is  not  known. 

Casein  is  an  acid  substance,  and  is  present  in 
combination  with  an  alkali,  chiefly  as  potassium 
caseinate.  The  casein  of  cows'  milk  is  readily  pre- 
cipitated by  dilute  acid,  and  is  thrown  down  in  large 
firm  masses;  that  of  human  milk  requires  more  acid 

a  yellow  layer  at  the  top;  this  layer  should  have  the  depth  of 
ten  or  twelve  spaces.  Beakers  with  a  scale  cut  in  the  glass  are 
now  sold  in  instrument  shops  under  the  name  of  "creamometers." 


FIG.  1 8. — SPECIFIC 
GRAVITY  GLASS 
AND  CREAM 
BEAKER. 


FOOD 


173 


and  is  precipitated  in  fine,  soft  particles,  which  are 
dissolved  by  an  excess  of  acid.  After  the  separation 
of  the  casein,  the  lactalbumin  is  left  in  solution  in 
the  whey.  Lactalbumin  closely  resembles  serum 
albumin,  is  unaffected  by  acid,  but  is  precipitated 
by  boiling. 

The  relative  proportions  of  casein  and  lactalbumin 
have  been  determined  with  sufficient  accuracy  to 
point  out  the  most  important  of  all  the  differences 
between  the  two  secretions,  which  is,  that  the  frac- 
tion of  the  total  albuminoids  in  cows'  milk  which 
is  coagulable  by  acids  (casein)  is  far  greater  than  the 
non-coagulable  part  (lactalbumin).  In  woman's 
milk,  on  the  contrary,  the  reverse  is  true,  and  the 
non-coagulable  part  much  exceeds  the  coagulable 
portion.  The  following  table  shows  this  difference: 


Human 

Cow's 

milk. 

milk. 

Total  proteids... 

i.  80 

3-50 

Casein  

0.60 

3  .OO 

Lactalbumin  .... 

i  .20 

0.50 

Taking  weight  for  weight  of  each  secretion,  the 
coagulum  of  human  milk  is  only  one-fifth  that  of 
cows'  milk.  This  difference  is  readily  tested  by 


174  HYGIENE   OF   THE   NURSERY 

adding  rennet  to  the  two  fluids.  In  the  case  of 
cow's  milk  the  casein  is  coagulated  into  large,  firm 
masses,  while  with  human  milk  a  light,  loose  curd 
is  formed.  In  the  stomach  the  acid  gastric  juice 
has  the  same  effect,  producing  in  the  first  in- 
stance a  coagulum  most  difficult  to  digest;  in  the 
other,  one  of  vastly  less  bulk  and  readily  attacked 
and  broken  down  by  the  gastro-intestinal  solvents. 

These  chemical  and  physical  properties  of  cows' 
milk  can  be  altered  by  various  methods  of  prepa- 
ration, and  unless  this  be  done  there  are  few  in- 
stances in  which  it  will  not  prove  a  poor  substitute 
for  the  natural  food. 

Condensed  milk  is  frequently  recommended  by 
physicians  and  largely  used  by  the  laity  on  their 
own  responsibility.  It  keeps  better  than  cows'  milk 
and  is  supposed  to  be  more  readily  digested  by 
young  infants.  The  latter  supposition  is  a  mis- 
taken one,  and  arises  from  the  overlooked  fact  that 
condensed  milk  is  always  given  dissolved  in  a  large 
proportion  of  water  (i  part  to  12-10-8  or  6,  according 
to  the  age  of  the  child),  while  cows'  milk  is  too  fre- 
quently used  insufficiently  diluted  or  otherwise  im- 
properly prepared.  The  author  is  convinced  of  the 
accuracy  of  this  statement  from  a  number  of  years' 
close  study  of  the  subject. 

Condensed  milk  contains  a  large  proportion  of 
sugar,  forms  fat  quickly,  and  thus  makes  large 


FOOD  175 

babies;  sugar  also  counteracts  in  some  degree 
the  tendency  to  constipation — often  a  troublesome 
complaint  in  hand-feeding.  These  advantages  are 
unquestioned,  and,  together  with  the  ease  of  prepa- 
ration and  the  fact  that,  when  in  good  condition,  it 
is  sterile  or  free  from  bacteria,  are  those  which  place 
it  so  high  in  the  esteem  of  monthly  nurses.  It  is 
equally  true,  however,  that  prepared  as  a  food  it 
does  not  contain  enough  nutrient  material,  either 
in  the  form  of  fat  or  proteids,  to  supply  the  wants 
of  a  growing  baby. 

Again,  more  than  half  of  the  saccharine  ingre- 
dient of  this  preparation  is  cane  sugar,  added  for 
the  purpose  of  preservation,  and  this  material  is 
very  liable,  when  in  excess,  to  ferment  in  the  ali- 
mentary canal,  giving  rise  to  irritant  products  that 
impede  digestion. 

Infants  fed  upon  condensed  milk,  though  fat,  are 
pale,  lethargic  and  flabby;  although  large,  are  far 
from  strong;  have  little  power  to  resist  diseases; 
frequently  develop  scurvy;  often  cut  their  teeth  late, 
and  are  very  likely  to  drift  into  rickets.  It  must  be 
remembered  also  that  condensed  milk,  when  long 
kept,  or  when  packed  in  imperfect  cans,  not  unfre- 
quently  undergoes  decomposition,  and  thus  becomes 
utterly  unfit  for  use. 

For  a  temporary  change  of  diet,  and  as  a  sub- 
stitute during  traveling  or  under  circumstances  in 


176  HYGIENE   OF  THE  NURSERY 

which  sound  cows'  milk  cannot  be  obtained,  it  may 
be  resorted  to  with  advantage.  Again,  for  feeding 
very  young  infants  when  a  sterile  food  of  low 
albuminoid  percentage  is  indicated,  it  may  some- 
times prove  useful,  but  the  necessity  of  adding 
fat,  in  the  form  of  cream,  must  always  be  insisted 
upon. 

The  farinaceous  substances  so  often  selected, 
especially  by  the  poor,  to  replace  breast  milk,  are 
not  only  bad  foods,  but  have  both  directly  and  in- 
directly a  deleterious  effect  upon  the  processes  of 
nutrition. 

They  are  bad  for  two  reasons.  First,  they  differ 
materially  in  chemical  composition  from  human 
milk.  For  example,  in  arrowroot,  which  is  the 
favorite,  the  proportion  of  the  tissue-building  to  the 
heat-producing  element  is  as  one  to  twenty,  while 
in  human  milk  it  is  about  one  to  five.  Second,  the 
heat-producing  principle,  starch,  must  be  converted 
into  sugar  before  it  can  be  absorbed.  This  change 
is  accomplished  in  the  body  by  the  saliva  and  pan- 
creatic juice — secretions  that  are  not  fully  estab- 
lished until  the  fourth  month. 

While  the  starch  lies  undigested  in  the  gastro- 
intestinal canal,  it  is  subject  to  fermentation,  result- 
ing in  the  formation  of  irritant  products  that  rapidly 
induce  catarrh  of  the  mucous  membrane — a  con- 
dition directly  interfering  with  the  digestion  and 


FOOD  177 

absorption  of  food.  Again,  perfect  nutrition  de- 
mands rapid  waste  and  removal  of  effete  tissues 
as  well  as  repair  of  the  same.  This  is  effected  by 
oxidation.  Now,  sugars  are  known  to  have  a  much 
greater  affinity  for  oxygen  than  albuminoids,  and 
when  the  diet  consists  of  farinaceous  material,  the 
small  amount  of  sugar  formed  and  absorbed  appro- 
priates oxygen  that  otherwise  would  go  toward  the 
removal  of  waste,  and  so  retards  the  necessary 
changes.  The  persistent  and  exclusive  use  of  this 
class  of  food  always  leads  to  a  condition  of  mal- 
nutrition which  may  result  in  simple  atrophy,  scurvy 
or  rickets,  while  the  irritant  products  of  fermenta- 
tion often  produce  sufficient  gastro-intestinal  dis- 
turbance to  cause  death. 

Farinaceous  food,  as  such,  is  therefore  never  per- 
missible before  the  later  months  of  infancy,  and 
then  only  as  an  adjunct  to  properly  modified  milk 
mixtures.  It  may  be  employed  earlier  for  its 
mechanical  action,  with  milk  mixtures,  and  in 
properly  selected  cases  proves  very  useful  in  this 
way.  The  purpose  of  this  method  of  employment 
will  be  considered  later  under  the  head  of  Atten- 
uants. 

The  nutrient  value  of  the  cereals  and  their  prod- 
ucts, as  they  exist  in  so-called  "infants'  foods," 
has  been  imperfectly  determined.  They  are  un- 
doubtedly useful  as  mechanical  attenuants,  but  it 

12 


178  HYGIENE    OF   THE   NURSERY 

is  very  certain  that  none  of  them,  unless  prepared 
with  milk,  can  permanently  meet  the  demand  of 
nutrition.  At  the  same  time  it  is  quite  probable 
that  the  albuminoids  with  the  soluble  carbohy- 
drates (maltose)  obtained  by  Liebig's  process  have 
a  food  value  of  their  own,  making  them  more 
serviceable  than  the  starches. 

b.  The  quantity  of  food  to  be  allowed  each  day 
varies  with  the  appetite  and  age.  Some  infants 
habitually  eat  little,  others  much;  as  both  thrive, 
the  question  of  the  correct  amount  in  a  given  case 
must  be  answered  by  observation.  So  long  as  the 
child  develops  with  normal  rapidity  and  keeps  well 
he  may  be  allowed  to  eat  as  much  or  as  little  as  he 
wants;  for,  if  food  of  proper  strength  be  given  at 
proper  intervals,  the  instinctive  cravings  of  hunger, 
since  they  represent  the  wants  of  the  system,  rarely 
lead  to  excess  in  either  direction.  Nevertheless,  it 
is  well  to  have  some  guide. 

During  the  first  four  weeks,  infants  generally 
require  from  twelve  to  seventeen  fluidounces  of 
food;  in  the  second  and  third  months,  about  thirty 
fluidounces,  and  from  this  time  to  the  twelfth 
month  from  two  to  two  and  one-half  or  even  three 
pints.  After  the  twelfth  month  the  quantity 
depends  upon  whether  additions  be  made  to  the 
diet,  or  milk  food  be  used  exclusively.  When  the 
daily  amount  reaches  three  pints,  the  limit  of  the 


FOOD  179 

capacity  of  the  stomach  is  usually  attained,  and 
the  greater  demand  for  nutriment,  as  growth  ad- 
vances month  by  month,  must  be  met  by  adding 
to  the  strength  of  the  food  rather  than  by  increasing 
its  bulk.  These  two  factors,  strength  and  quantity, 
are  intimately  associated  throughout  the  whole 
period  of  infancy,  and  in  the  earlier  months  a  mere 
increase  in  the  latter  is  not  always  sufficient  to 
maintain  the  balance  of  nutrition. 

As  a  rule,  infants  are  overfed,  and  this  opens  the 
very  interesting  question  of  the  normal  capacity  of 
the  stomach  at  different  ages.  Rotch  states  that, 
by  actual  measurement,  the  stomach  of  an  infant 
five  days  old  holds  25  c.c.,  or  six  and  one-quarter 
fluidrachms,  a  quantity  very  far  short  of  that  usu- 
ally forced  upon  the  baby  during  the  first  week. 
Frowlowsky's  investigations  show  that  there  is  a 
very  rapid  increase  in  the  capacity  of  the  stomach 
during  the  first  two  months  of  life,  while  in  the 
third,  fourth  and  fifth  months  the  increase  is  slight. 
Guided  by  these  data,  the  quantity  of  food  should 
be  rapidly  augmented  during  the  first  six  or  eight 
weeks  of  life  and  then  held  at  the  same  quantity  up 
to  the  fifth  or  sixth  month.  Another  considerable 
increase  is  also  demanded  between  the  sixth  and 
the  tenth  months. 

The  author  has  been  unable  to  verify  the  above 
measurements,  and  has,  on  the  contrary,  found  no 


I$0  HYGIENE   OF   THE   NURSERY 

uniformity  in  the  size  of  the  stomach  for  given  ages; 
still  clinical  experience  is  a  sufficient  guide,  and 
upon  this  the  following  table  is  based: 


TABLE  OF  INTERVALS  OF  FEEDING  AND  AVERAGE  AMOUNTS 
OF  FOOD. 


Age. 

Intervals 
of 
feeding. 

Average  amount 
at  each 
feeding. 

Average  amount 
in  24  hours. 

During  first  week.  .  .  . 

2  hours. 

i  ounce. 

12  ounces. 

From  second  to  sixth 
week. 

2  hours. 

ii  to  2  ounces. 

12  to  17  ounces. 

From  sixth  week  to 
third  month. 

2  hours. 

3  to  4  ounces. 

24  to  30  ounces. 

From  third  to  sixth 
month. 

z\  hours. 

4  to  6  ounces. 

32  to  36  ounces. 

At  ten  months  

3  hours. 

8  ounces. 

40  ounces. 

c.  The  object  to  be  accomplished  in  the  prepara- 
tion or  modification  of  cows'  milk  is  to  make  it  re- 
semble human  milk  as  much  as  possible  in  chemical 
composition  and  physical  properties.  To  do  this 
it  is  necessary  to  reduce  the  proportion  of  proteids, 
to  increase  the  proportion  of  sugar,  and  to  overcome 
the  tendency  of  the  casein  to  coagulate  into  large, 
firm  masses  upon  entering  the  stomach  and  coming 
in  contact  with  the  acid  gastric  juice. 


FOOD  l8l 

Dilution  with  water  is  all  that  need  be  done  to 
reduce  the  amount  of  proteids  to  the  proper  level; 
but  as  this  diminishes  the  already  insufficient  sugar, 
and  also  the  fat,  it  is  essential  to  add  these  materials 
to  the  mixture  of  milk  and  water.  Fat  is  best  added 
in  the  form  of  gravity  cream  which  contains  approx- 
imately 1 6  per  cent,  of  fat;  and  of  the  sugars,  either 
pure  white  loaf  sugar  or  sugar  of  milk  of  good 
quality  may  be  used.  The  latter  is  greatly  pref- 
erable, because  it  is  the  natural  sugar,  is  directly 
assimilable,  in  the  process  of  digestion  is  converted 
into  lactic  acid,  and,  unlike  cane  sugar,  is  not 
readily  fermented.  One  ounce  of  milk  sugar  to 
twenty  ounces  of  food  properly  proportioned 
for  the  first  four  months,  gives  a  sugar  percent- 
age similar  to  human  milk,  i.  e.,  6  to  7  per  cent. 
If  cane  sugar  be  used,  one-half  the  quantity  is 
required. 

Firm  clotting  may  be  prevented  by  the  addition 
of  an  alkali  or  a  small  quantity  of  some  thickening 
substance  or  attenuant. 

Lime-water  is  the  alkali  usually  selected.  It 
neutralizes  the  slightly  acid  reaction  which  usually 
characterizes  market  milk  and  has  a  further  chemi- 
cal action  which  is  variously  explained.  Some 
authorities  claim  that  to  the  extent  of  the  quantity 
of  lime-water  added  a  soluble  calcium  caseinate  is 
formed  which  is  not  acted  upon  by  the  acid  gastric 


1 82  HYGIENE    OF   THE   NURSERY 

juice  with  the  precipitation  of  firm  curds.  Others, 
that  lime-water  causes  the  mucoid  proteids  (Storch) 
of  the  milk  to  swell  up  and  become  viscid,  thus 
tending  to  gelatinize  the  curd,  and  by  its  alkaline 
properties  to  retard  the  curdling  action  of  the  gas- 
tric secretion.  Whichever  theory  is  accepted  the 
result  is  the  same,  the  total  bulk  of  casein  coagulum 
is  diminished  and  the  ease  of  digestion  increased. 
To  produce  measurable  results  the  quantity  of 
lime-water  to  be  used  must  always  be  in  the  propor- 
tion of  one  part  to  twenty  of  milk  mixture.  When 
lime-water  is  constantly  employed,  it  becomes  quite 
an  item  of  expense  if  procured  from  the  chemist's. 
This  outlay  is  unnecessary,  for  it  can  be  made  quite 
as  well  in  the  nursery.  Take  one  heaping  teaspoon- 
ful  of  slaked  lime  and  put  it  with  one  quart  of 
boiled  or  distilled  water  into  a  bottle,  cork  securely, 
and  shake  thoroughly  two  or  three  times,  at  intervals 
of  half  an  hour;  then  allow  to  settle  and  after 
twenty-four  hours  siphon  off  for  use  the  upper 
clear  fluid;  this  must  be  kept  in  a  well-stopped, 
perfectly  clean  bottle. 

Instead  of  lime-water,  bicarbonate  of  sodium  may 
be  added  to  each  bottle  in  the  proportion  of  one 
grain  to  each  fluidounce  of  milk  mixture;  or,  better 
still,  from  five  to  fifteen  drops  of  the  saccharated 
solution  of  lime.  This  solution  is  made  in  the 
following  way : 


FOOD  183 

Take  of— 

Slaked  lime i  ounce. 

Refined  sugar,  in  powder 2  ounces. 

Distilled  water i  pint. 

Mix  the  lime  and  sugar  by  trituration  in  a  mortar.  Transfer  the 
mixture  to  a  bottle  containing  the  water,  and  having  closed  this 
with  a  cork,  shake  it  occasionally  for  a  few  hours.  Finally, 
separate  the  clear  solution  with  a  siphon  and  keep  it  in  a 
stoppered  bottle. 

Thickening  substances,  attenuants,  are  employed 
to  act  in  the  main  mechanically  by  getting,  as  it 
were,  between  the  particles  of  casein  during  coagu- 
lation, preventing  their  running  together  and  form- 
ing a  large  compact  mass.  This  class  embraces 
gummy  materials  like  dextrin,  gelatin,  the  various 
infants'  foods  prepared  by  Liebig's  process  (in 
which  the  starch  of  wheat  and  barley  is  converted 
into  maltose  and  dextrin),  and  finely  divided  starch 
as  it  exists  in  barley-  or  oatmeal- water;  and  it  is  for 
this  purpose  only  that  starch  is  permissible  as  an 
element  of  diet  in  infancy.  Barley-water  and  gela- 
tin* are  the  attenuants  usually  employed. 

When  an  "infant's  food"  is  used  to  act  mechanic- 
ally, care  should  be  taken  to  select  a  reliable  one, 
that  is,  one  in  which  the  starch  has  been  converted 
into  maltose  and  dextrin  by  the  process  of  manu- 
facture. The  articles  known  as  Mellin's  Food  and 
Horlick's  Food  can  be  relied  upon.  One  teaspoon- 

*See  Chapter  IX. 


184  HYGIENE    OF   THE   NURSERY 

ful  of  either  dissolved  in  a  tablespoonful  of  hot  water 
and  added  to  each  portion  of  food,  makes  a  very  easily 
digested  mixture.  Dry  malt  extracts  also  act  well 
mechanically,  being  especially  useful  when  desirable 
to  reinforce  the  fat-building  elements  of  the  food. 

It  must  not  be  inferred  from  what  has  been  stated 
in  regard  to  the  use  of  lime-water  and  attenuants 
that  these  are  essentials  in  the  artificial  feeding  of 
infants.  On  the  contrary,  the  majority  of  healthy 
babies  require  only  sound  cows'  milk,  properly 
modified  by  the  addition  of  cream,  milk  sugar,  and 
water.  It  is  best  to  leave  the  addition  of  lime- 
water,  bicarbonate  of  sodium,  or  an  attenuant,  to 
the'judgment  of  the  physician. 

For  the  successful  management  of  children,  the 
mother  or  nurse  must  not  only  be  familiar  with  the 
theory  of  feeding,  but  must  practically  understand 
the  methods  of  preparing  food.  To  this  end  a 
schedule  of  the  diet  of  an  infant  from  birth  upward, 
with  a  sketch  of  the  modifications  that  have  to  be 
made  most  frequently,  will  serve  as  a  useful  guide. 

Diet  during  the  first  week: 

Gravity  cream*  (16%) .  .   2    teaspoonfuls. 

Whey 3    teaspoonfuls. 

Water,  98°-ioo°  F 3    teaspoonfuls. 

Milk  sugar £  teaspoonful. 

*  Gravity  cream  is  obtained  by  skimming  after  milk  has  stood 
for  twenty-four  hours.  Ordinary  centrifugal  cream  has  18-20  per 
cent.  fat.  Heavy  centrifugal  cream  has  35-40  per  cent.  fat. 


FOOD  185 

For  each  portion;  to  be  given  every  two  hours  from  5  A.M.  to 
ii  P.M.,  and  in  some  cases  once  or  twice  at  night;  amounting 
to  twelve  fluidounces  of  food  per  diem. 

Diet  from  the  second  to  the  sixth  week: 

Gravity  cream  (16%) ...  2    teaspoonfuls     (fid.  oz.  J). 

Milk i    tablespoonful    (fld.  oz.  £). 

Milk  sugar $  teaspoonf ul. 

Water 2    tablespoonfuls  (fld.  oz.  i). 

For  one  portion;  to  be  given  every  two  hours  from  6  A.M.  to  10 
P.M.  and  once  during  the  night;  amounting  to  seventeen  fluid- 
ounces  of  food  per  diem. 

Diet  from  the  sixth  week  to  the  end  of  the  second 
month : 

Gravity  cream  (16%) .  .  .    i    tablespoonful    (fld.  oz.    $). 

Milk 2 J  tablespoonfuls  (fld.  oz.  i£). 

Milk  sugar £  teaspoonf  ul. 

Water z\  tablespoonfuls  (fld.  oz.  i|). 

For  each  portion;  to  be  given  every  two  hours;  amounting  to 
thirty  fluidounces  per  diem. 

Diet  from  the  beginning  of  the  third  month  to  the 
sixth  month: 

Gravity  cream  (16%) ...    i  tablespoonful    (fld.  oz.    £). 

Milk 4  tablespoonfuls  (fld.  oz.  2  ) . 

Milk  sugar i  teaspoonf  ul. 

Water 3  tablespoonfuls  (fld.  oz.  ij). 

For  each  portion;  to  be  given  every  two  and  one-half  hours; 
thirty-two  fluidounces  per  diem. 


1 86  HYGIENE   OF   THE   NURSERY 

Diet  during  the  sixth  and  seventh  months;  six 
meals  daily: 

Gravity  cream  (16%) . .  .   i  tablespoonful    (fld.  oz.    J). 

Milk 7  tablespoonfuls  (fld.  oz.  3^). 

Milk  sugar i  teaspoonful. 

Water 4  tablespoonfuls  (fld.  oz.  2  ). 

For  each  portion;  to  be  given  every  three  hours  from  6  or  7  A.M. 
to  9  or  10  P.M.;  thirty-six  fluidounces  per  diem. 

Often  a  pinch — gr.  2  to  5 — of  table  salt  is  of 
service,  and  may  be  added,  after  the  second  week, 
to  each  portion  of  food. 

A  table  of  the  dietary,  as  far  as  it  has  been  carried, 
may  be  useful  for  convenience  of  reference  (page 
187). 

Throughout  the  eighth  and  ninth  months  five 
meals  a  day  will  be  sufficient,  each  meal  composed 
of 

Gravity  cream  (16%) .  .  .     i  tablespoonful    (fld.  oz.    £). 

Milk 12  tablespoonfuls  (fld.  oz.  6  ). 

Milk  sugar i  teaspoonful. 

Water 3  tablespoonfuls  (fld.  oz.  ij). 

This  allows  forty  fluidounces  of  food  per  diem. 

At  this  age  it  is  sometimes  advisable  to  supple- 
ment the  milk  mixture  with  one  of  the  reliable  in- 
fants' foods  (Liebig  foods);  thus,  two  teaspoonfuls 
of  Mellin's  food  may  be  added  to  the  second,  third, 
and  fourth  meals,  the  milk  sugar  being  then  omitted. 
Instead  of  Liebig  food,  one  of  the  wheat  or  barley 


FOOD 


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1 88  HYGIENE   OF   THE   NURSERY 

flours  prepared  by  baking  or  by  diastase  digestion 
may  be  used.  Baking  at  a  temperature  of  300°  to 
400°  converts  the  starch  into  dextrin;  treatment 
with  diastase  produces  maltose  and  dextrin.  The 
best  examples  of  the  baked  flours  are  Blair's  Wheat 
Flour,  Imperial  Granum,  and  Robinson's  Barley. 
In  selecting  a  Liebig  food  or  baked  flour  as  an  ad- 
juvant, one  must  be  influenced  by  the  condition  of 
the  infant  to  be  fed.  A  baked  flour  is  indicated 
when  there  is  a  tendency  to  too  frequent  and  liquid 
faecal  evacuations,  as  it  has  a  somewhat  astringent 
action,  and  is  to  be  avoided  in  cases  of  sluggish 
bowels  and  constipation.  Under  the  latter  con- 
ditions a  Liebig  food — Mellin's,  for  instance — 
should  be  used,  as  a  laxative  action  is  desirable. 

Diet  from  the  tenth  to  the  fourteenth  month,  five 
meals  daily: 

Gravity  cream  (16%) i  tablespoonful    (fld.  oz.    J). 

Milk 15  tablespoonfuls  (fld.  oz.  7^). 

Milk  sugar i  teaspoonful. 

(Flour-ball  or  barley  jelly*          2  teaspoonfuls.) 

Water. 3  tablespoonfuls  (fld.  oz.  ij). 

In  using  flour-ball,  rub  two  teaspoonfuls  of  the  powder  with 
a  tablespoonful  of  milk  into  a  smooth  paste,  then  add  a  second 
tablespoonful  of  milk,  constantly  rubbing  until  a  cream-like 
mixture  is  obtained;  finally,  stir  into  the  mixture  of  cream,  milk, 
milk  sugar  and  water. 

*  See  Chapter  IX. 


FOOD  189 

Occasionally,  about  the  end  of  the  first  year,  a 
child  may  require  a  more  varied  and  substantial 
diet;  for  example: 

First  meal,  7  A.M. — Milk  mixture  as  above. 

Second  meal,  10.30  A.M. — A  breakfast-cupful  of 
warm  milk  (eight  fluidounces). 

Third  meal,  2  P.M. — The  yolk  of  an  egg  lightly 
boiled,  with  stale  bread  crumbs. 

Fourth  meal,  6  P.M. — Same  as  first. 

Fifth  meal,  10  P.M. — Same  as  second. 

On  alternate  days  the  third  meal  may  consist  of 
a  teacupful  (six  fluidounces)  of  beef-,  mutton-,  or 
chicken-broth,  containing  a  few  stale  bread  crumbs. 

Diet  from  the  fourteenth  to  eighteenth  month,  five 
meals  a  day: 

First  meal,  7  A.M. — A  slice  of  stale  bread,  broken 
and  soaked  in  a  breakfast-cupful  (eight  fluidounces) 
of  milk;  or  two  tablespoonfuls  of  well-cooked  and 
strained  porridge  (oatmeal  or  cracked  wheat),  with 
two  tablespoonfuls  of  cream  and  a  little  salt  (no 
sugar) ;  a  breakfast-cupful  of  new  milk. 

Second  meal,  10  A.M. — A  teacupful  of  milk  (six 
fluidounces)  with  a  soda  biscuit  or  thin  slice  of 
lightly  buttered  bread. 

Third  meal,  2  P.M. — A  teacupful  (six  fluidounces) 
of  beef-,  chicken-,  or  mutton-broth,  with  a  slice  of 
bread;  one  good  tablespoonful  of  rice-and-milk 
pudding. 


1 90  HYGIENE   OF   THE   NURSERY 

Fourth  meal,  6  P.M. — Bread  and  milk,  strained 
porridge  and  cream,  with  milk,  as  at  first  meal. 

Fifth  meal,  10  P.M. — A  breakfast-cupful  of  milk 
with  or  without  one  tablespoonful  of  a  good  Liebig 
food. 

To  alternate  with  this: 

First  meal,  7  A.M. — The  yolk  of  an  egg  lightly 
boiled,  with  bread  crumbs;  a  teacupful  of  milk. 

Second  meal,  10  A.M. — A  teacupful  of  milk  with 
a  thin  slice  of  lightly  buttered  bread. 

Third  meal,  2  P.M. — A  mashed  baked  potato, 
moistened  with  four  tablespoonfuls  of  meat  broth; 
two  good  tablespoonfuls  of  junket,  with  the  same 
quantity  of  cream. 

Fourth  meal,  6  P.M. — A  breakfast-cupful  of 
milk  with  a  slice  of  bread  broken  up  and  soaked 
in  it. 

Fifth  meal,  10  P.M. — A  teacupful  of  milk. 

The  fifth  meal  is  often  unnecessary,  and  sleep 
should  never  be  disturbed  for  it.  Should  the  child 
awake  at  5  or  6  A.M.  he  should  have  a  cup  of  warm 
milk,  and  not  be  allowed  to  go  hungry  until  the  set 
breakfast  hour. 

Diet  from  eighteen  months  to  the  end  of  two  and 
one-half  years,  four  meals  a  day: 

First  meal,  7  A.M. — A  breakfast-cupful  of  milk; 
a  lightly  boiled  egg,  with  a  little  butter  and  salt; 
two  thin  slices  of  bread  and  butter. 


FOOD  igi 

Second  meal,  n  A.M. — A  teacupful  of  milk  with 
a  plain  biscuit  or  slice  of  bread. 

Third  meal,  2  P.M. — A  breakfast-cupful  of  beef-, 
mutton-,  or  chicken-broth;  a  thin  slice  of  stale 
bread;  a  saucer  of  rice-and-milk  pudding. 

Fourth  meal,  6.30  P.M. — A  breakfast-cupful  of 
milk,  with  bread  and  butter. 
On  alternate  days : 

First  meal,  7  A.M. — Two  tablespoonfuls  of  thor- 
oughly cooked  oatmeal  or  wheaten  grits,  with  two 
tablespoonfuls  of  cream  and  a  little  salt  (no  sugar) ; 
a  teacupful  of  milk. 

Second  meal,  u  A.M. — A  teacupful  of  milk  with 
a  slice  of  bread  and  butter. 

Third  meal,  2  P.M. — One  tablespoonful  of  under- 
done mutton  pounded  to  a  paste;  bread  and 
butter,  or  mashed  baked  potato,  moistened  with 
good,  plain  dish  gravy;  a  saucer  of  junket  and 
cream. 

Fourth  meal,  6.30  P.M. — A  breakfast-cupful  of 
milk,  a  slice  of  soft  milk-toast,  or  a  slice  or  two  of 
bread  and  butter. 

Diet  from  two  and  one-half  to  three  and  one-half 
years,  four  meals  daily: 

First  meal,  7.30  A.M. — One  or  two  tumblerfuls 
of  milk;  a  saucer  of  thoroughly  cooked  oatmeal  or 
wheaten  grits  with  cream  and  salt,  and  one  or  two 
slices  of  bread  (one  day  old)  and  butter. 


I Q2  HYGIENE   OF   THE   NURSERY 

Second  meal,  n  A.M.  (if  hungry). — A  tumblerful 
of  milk,  or  a  teacupful  of  meat-broth,  with  a 
biscuit. 

Third  meal,  2  P.M. — A  slice  of  underdone  roast 
beef  or  mutton,  or  a  bit  of  roast  chicken  or  turkey, 
minced  as  fine  as  possible;  a  baked  potato  thorough- 
ly mashed  with  a  fork  and  moistened  with  gravy; 
a  slice  or  two  of  bread  and  butter;  a  saucer  of  junket 
or  rice-and-milk  pudding. 

Instead  of  the  potato,  well-boiled  rice  or  plainly 
dressed  macaroni  may  be  allowed  for  variety,  or  one 
well-cooked  green  vegetable — i.e  .,  spinach,  celery, 
young  onions,  cauliflower,  and  young  peas  mashed 
with  a  fork. 

Fourth  meal,  7  P.M. — A  tumblerful  of  milk;  one 
or  two  slices  of  bread  and  butter  or  of  well-moistened 
milk-toast;  a  baked  apple,  or  stewed  prunes,  or 
apples. 

An  important  point,  often  neglected,  is  the  matter 
of  drink.  Even  the  youngest  infant  requires  water 
several  times  daily,  and  the  demand  increases  with 
age,  so  that  the  amount  taken  at  one  time  will 
range  from  one  to  eight  ounces.  The  drinking 
water  must  be  as  pure  as  possible  and  should  not 
be  too  cold.  In  the  heat  of  summer,  however, 
water  moderately  cooled  by  ice  may  be  allowed 
without  harm. 

The  fresh-strained  juice  of  sweet  oranges  is  a 


FOOD  193 

useful  addition  to  the  diet  especially  when  there  is 
a  tendency  to  constipation.  At  the  fifth  or  sixth 
month  two  or  three  teaspoonfuls  diluted  with  an 
equal  quantity  of  water  and  with  a  little  sugar 
may  be  given  an  hour  before  the  second  or  third 
feeding,  and  the  quantity  gradually  increased  as 
age  advances,  so  that  at  one  year  the  child  may  take 
from  one  to  two  ounces. 

The  foregoing  schedule  must,  of  course,  be  re- 
garded as  an  average.  Some  children  can  bear 
nothing  but  milk  food  up  to  the  age  of  two  or  even 
three  years,  and,  provided  enough  be  taken,  no 
fear  for  their  nutrition  need  be  entertained.  If  a 
child  be  thriving  on  milk,  he  is  never  to  be  forced  to 
take  additional  food  merely  because  a  certain  age 
has  been  reached;  let  the  healthy  appetite  be  the 
guide. 

A  young  mother,  in  her  solicitude  to  do  her  best, 
often  finds  great  difficulty  in  adhering  to  simple 
rules  in  the  diet  of  her  child.  Mrs.  A.,  who  has  had 
great  experience  with  children,  having  had  some 
herself,  tells  her  that  the  child  would  thrive  far 
better  if  it  ate  such  and  such  a  thing,  and  did  not 
keep  to  weak  milk  foods.  Miss  B.  assures  her  that 
her  cousin's  last  child  grew  much  healthier  after 
eating  a  chop  with  vegetables  and  pudding  each 
day.  Aunt  C.  comes  with  the  announcement — 
which  she  breaks  gently — that  she  knows  the  child 


1 94  HYGIENE   OF   THE   NURSERY 

is  simply  starving,  and  the  ignorant  nurse  confirms 
the  statement. 

All  their  seemingly  convincing  theories  are  very 
upsetting  to  a  mother  who  wants  only  to  do  what 
is  right.  She  must  bear  in  mind,  however,  that 
some  children  can  eat  anything  and  live;  but  she 
does  not  know  how  much  better,  more  robust,  and 
disease-resisting  they  would  be,  did  they  adhere  to 
a  simple  diet.  Let  her  remember  that  the  so-called 
"weak  milk  foods"  contain  those  nourishing  quali- 
ties to  which  nature,  in  her  wisdom,  has  limited  the 
child's  powers  of  digestion.  Therefore,  young 
mothers,  let  well  enough  alone. 

Much  more  difficulty  is  experienced  in  feeding 
infants  during  the  first  twelve  months  than  during 
the  second.  It  will  be  well,  therefore,  to  consider 
what  would  best  be  done  in  case  the  suggested  milk 
modifications  should  disagree. 

If,  after  feeding,  vomiting  occur,  with  the  expul- 
sion of  large,  firm  clots  of  casein,  or  if  there  be 
diarrhoea  with  the  expulsion  of  curds,  the  effect  of 
adding  lime-water  or  barley-water  must  be  tried. 

For  instance,  at  the  age  of  six  weeks,  make  each 
bottle  of— 

Gravity  cream  (16%) ....  i    tablespoonful    (fld.  oz.    J). 

Milk 2    tablespoonfuls  (fld.  oz.  i  ). 

Milk  sugar J  teaspoonful. 

Lime-water i    tablespoonful    (fld.  oz.    J). 

Water 2    tablespoonfuls  (fld.  oz.  i  ). 


FOOD  195 

Orof- 

Grayity  cream  (16%) ....  i    tablespoonful    (fld.  oz.    i). 

Milk 2    tablespoonfuls  (fld.  oz.  i  ). 

Milk  sugar \  teaspoonful. 

Barley-water 3    tablespoonfuls  (fld.  oz.  ij). 

Sometimes,  particularly  if  there  be  diarrhoea,  boil- 
ing makes  the  milk  more  tolerable,  and  in  this  con- 
dition it  may  be  used  instead  of  fresh  milk  in  either 
of  the  above  mixtures.  Condensed  milk,  too,  can 
be  employed  temporarily,  making  each  portion  of— 

Gravity  cream  (16%) .  .  .  .   i  tablespoonful    (fld.  oz.    £). 

Condensed  milk i  teaspoonful. 

Hot  water 5  tablespoonfuls  (fld.  oz.  2j). 

Another  good  food  is  that  recommended  by  the 
late  Dr.  A.  V.  Meigs.  It  consists  of  a  combination 
of  two  parts  of  the  cream,  containing  from  fourteen 
to  sixteen  per  cent,  of  fat;  one  part  average  milk;  two 
parts  lime-water,  and  three  parts  sugar-water,  the 
latter  consisting  of  seventeen  and  three-fourths 
drachms  (about  eighteen  teaspoonfuls)  of  milk  sugar 
to  one  pint  of  water.  This  makes  an  alkaline  mix- 
ture with  the  percentage  of  its  ingredients  closely 
corresponding  to  human  milk. 

Whey*  combined  with  cream  and  barley-water  is 
more  readily  retained  and  digested  than  any  of  the 
above  combinations,  and  may  be  usefully  employed 
whenever  curds  are  expelled  by  vomiting  or  diar- 

*  See  Chapter  IX. 


196  HYGIENE   OF   THE   NURSERY 

rhoea;  provided  that  in  the  latter  condition  there  is 
not  sufficient  decomposition  of  the  intestinal  con- 
tents to  require  a  no-milk  diet.  Whey  contains  a 
small  amount  of  fat,  the  soluble  proteids  (lactalbu- 
min),  the  sugar  and  part  of  the  salts  of  milk.  On 
the  other  hand,  casein  is  practically  absent,  being 
clotted  by  the  rennet  and  separated  in  the  process 
of  preparation.  Knowing  its  composition  one  can 
easily  appreciate  its  value,  especially  when  combined 
with  cream  in  cases  where  casein  is  digested  with 
difficulty.  Of  course,  the  food  value  of  whey  is  less 
than  of  the  cows'  milk  from  which  it  is  made,  but 
as  a  temporary  substitute  in  acute  indigestion  and  as 
an  initial  food  in  cases  of  inherently  deficient  casein 
digestion,  its  usefulness  cannot  be  questioned.  A 
good  whey  mixture  for  an  infant  of  six  week  is — 

Gravity  cream  (16%) ..  2-4    teaspoonfuls     (fld.  oz.  f-J) . 

Whey 3    tablespoonfuls  (fld.  oz.  ij). 

Milk  sugar }  teaspoonful. 

Barley-water 3    tablespoonfuls  (fld.  oz.  ij). 

For  older  children  it  is  sufficient  to  double  the  cream  and  sugar 
and  increase  the  whey  and  barley-water  in  equal  quantities  to 
make  a  five-  or  six-ounce  bottle.  With  this  food,  too,  it  is 
easy  to  return  to  or  institute  milk  feeding  by  substituting 
each  day  a  small  measured  quantity  of  cow's  milk  for  an  equal 
measure  of  whey  until  the  proper  proportion  of  milk  for  the 
patient's  age  is  attained,  and  the  whey  is  supplanted  or  discarded. 

Under  the  same  conditions  that  whey  mixtures 
are  employed  the  process  known  as  predigestion 
frequently  gives  most  gratifying  results. 


FOOD  197 

Predigestion,  or  peptonization,*  is  best  accom- 
plished by  means  of  the  substance  called  pancreatin. 
That  manufactured  under  the  name  of  extractum 
pancreatis  by  Fairchild  Brothers  &  Foster,  of  New 
York,  has  proved  most  efficient  in  my  hands. 

It  is  sometimes  necessary  to  carry  the  artificial 
process  almost  or  quite  to  complete  digestion  of  the 
casein;  more  frequently  partial  predigestion  is 
sufficient. 

For  the  first;  put  into  a  clean  quart  bottle  five 
grains  of  extractum  pancreatis  and  fifteen  grains  of 
bicarbonate  of  sodium  (the  contents  of  a  "pepton- 
izing  tube"),  with  four  fluidounces  of  cool,  filtered 
water;  shake  thoroughly  together,  and  add  a  pint 
of  fresh,  cool  milk.  Place  the  bottle  in  water,  not  so 
hot  but  that  the  whole  hand  can  be  held  in  it  for  a 
minute  without  discomfort,  and  keep  the  bottle 
there  for  exactly  thirty  minutes.  At  the  end  of  that 
time  put  the  bottle  on  ice  to  check  further  digestion 
and  to  keep  the  milk  from  spoiling.  The  fluid 
obtained,  while  somewhat  less  white  in  color  than 
milk,  does  not  differ  from  it  in  taste;  if  however,  an 
acid  be  added,  the  casein,  instead  of  being  coagu- 
lated into  large  firm  curds,  takes  the  form  of  minute, 
soft  flakes,  or  readily  broken  down,  feathery  masses 


*  The    subject    of    peptonization    is    further    considered   in 
Chapter  IX. 


1 98  HYGIENE    OF   THE   NURSERY 

of  small  size.  When  the  process  is  carried  just  to 
the  point  described,  the  casein  is  only  partly  con- 
verted into  peptone;  but  every  succeeding  moment 
of  continued  warmth  lessens  the  amount  of  casein 
until  peptonization  is  complete.  Then  the  liquid  is 
grayish-yellow  in  color;  has  a  distinctly  bitter  taste, 
and  shows  no  coagulation  whatever  on  the  addition 
of  an  acid.  This  artificial  digestion,  therefore, 
may  be  carried  just  as  far  as  circumstances  indicate, 
although  it  is  ordinarily  best  to  stop  it  short  of 
complete  conversion,  as  children  object  to  the 
markedly  bitter  taste,  and  often,  on  account  of  it, 
absolutely  refuse  the  food.  Partial  peptonization, 
too,  is  usually  sufficient  to  adapt  the  milk  to  ready 
assimilation.  To  seize  the  proper  moment  for 
arresting  the  process,  the  person  conducting  it  must 
be  told  to  taste  the  milk  from  time  to  time,  and,  as 
soon  as  the  least  bitterness  is  appreciable,  remove 
the  bottle  from  the  hot  water  and  place  it  upon  ice 
for  cooling  and  use.  Such  milk  may  be  sweetened 
with  sugar  of  milk,  and  given  pure  or  diluted  with 
water.  For  an  infant  of  six  weeks  each  meal  may 
consist  of — 

Peptonized  milk 4    tablespoonfuls  (fld.  oz.  2). 

Milk  sugar £  teaspoonful. 

Water 2    tablespoonfuls  (fld.  oz.  i). 

To  this,  cream  may  be  added  when  desirable,  and 
by  diminishing  the  quantity  of  water  and  increasing 


FOOD  199 

that  of  milk  the  strength  of  the  food  may  be  made 
greater  at  any  time. 

Although  every  precaution  be  taken,  the  last  of 
a  quantity  of  predigested  food  is  very  apt  to  grow 
bitter;  and  if  the  attendants  will  take  the  trouble,  it 
is  much  better  to  peptonize  every  meal  separately. 
This  is  readily  done  by  obtaining  a  number  of  pow- 
ders of  pancreatin  and  bicarbonate  of  sodium,  so 
proportioned  that  each  packet  shall  contain  the 
proper  amount  for  one  bottle  of  food.  For  example : 

Take  of— 

Extractum  pancreatis 9  grains. 

Bicarbonate  of  sodium .   24  grains. 

Mix  and  divide  into  twelve  powders,  and  dispense  in  waxed  papers. 
DIRECTIONS. — Put  one  powder  into  a  nursing  bottle  with  two 
fluidounces  of  filtered  water  and  two  fluidounces  of  fresh 
sweet  milk;  shake  together  and  keep  warm  in  a  water-bath 
for  about  half  an  hour  before  feeding;  sweeten  with  half  a 
teaspoonful  of  milk  sugar. 

Partial  predigestion  is  the  most  useful  and  most 
uniformly  applicable  of  all  the  methods  of  modify- 
ing cows'  milk  for  infants  having  feeble  digestive 
powers.  For  this  purpose  I  have,  for  many  years, 
employed  the  material  known  as  Fairchild's  pep- 
togenic  milk  powder.  This  powder  contains  a 
digestive  ferment,  pancreatin;  an  alkali,  bicar- 
bonate of  sodium,  and  a  due  proportion  of  milk 
sugar.  It  is  in  no  sense  an  infant's  food,  and  as 
considerable  heat  (115°  F.)  is  required  to  insure  its 


200  HYGIENE    OF   THE   NURSERY 

action,  the  food  prepared  by  it  is  not  only  partially 
predigested,  but  also,  to  a  certain  extent,  Pasteur- 
ized, a  result  greatly  to  be  desired  under  certain 
conditions,  as  will  be  detailed  later.  The  mode  of 
employment  is  as  follows: 

Take  of— 

Gravity  cream  (16%) i  tablespoonful    (fld.  oz.  £). 

Milk 4  tablespoonfuls  (fld.  oz.  2). 

Water 4  tablespoonfuls  (fld.  oz.  2). 

Peptogenic  milk  powder. . .  i  level  teaspoonful.* 

This  mixture  is  heated  over  a  brisk  flame  to  115° 
F.,  kept  at  this  heat,  with  constant  stirring,  for 
six  minutes,  and  then  quickly  cooled  to  the  proper 
temperature  (98°  F.)  for  administration.  The  stir- 
ring is  best  done  with  a  food  thermometer,  as  this 
gives  a  constant  record  of  the  temperature,  and  the 
vessel  containing  the  mixture  must  be  moved  away 
from  or  nearer  to  the  source  of  heat  as  the  tempera- 
ture rises  above  or  falls  below  the  required  point. 
In  preparing  each  bottle  separately — by  far  the 
better  plan — the  mixture  should  never  be  heated  to 
the  boiling  point,  as  this  checks  the  action  of  the  pan- 
creatin,  and  all  digestive  action  after  ingestion  is 
lost.  On  the  other  hand,  when  the  whole  supply 
for  a  day  is  prepared  at  once,  the  required  bulk  of 
powder  for  the  quantity  of  milk  mixture  is  added, 

*  Measure  provided  with  jar  only  to  be  used  when  preparing, 
at  once,  the  whole  quantity  of  food  to  be  given  in  a  day. 


FOOD  2OI 

and  the  whole  is  heated  slowly  to  boiling,  ten  minutes 
being  occupied,  and  then  quickly  cooled.  Here  the 
object  is  to  stop  the  digestion,  so  that  the  portion 
to  be  used  later  in  the  day  may  not  be  fully  pep- 
tonized  and  bitter.  This  method  has  the  advantage 
of  effecting  more  perfect  Pasteurization.  When 
properly  prepared,  the  resultant  so-called  "  human- 
ized milk"  presents  the  casein  in  a  minutely  coagu- 
lable  and  digestible  form;  has  an  alkaline  reaction; 
contains  the  proper  proportion  of  salts,  milk  sugar, 
and  fat;  is  not  bitter  in  taste;  has  the  appearance  of 
human  milk,  and  by  Leeds' s  analysis  shows: 

Water 86 .2  per  cent. 

Fat 4.5  per  cent. 

Milk  sugar 7.0  per  cent. 

Albuminoids 2.0  per  cent. 

Ash  (salts) 0.3  per  cent. 

This  corresponds  very  closely  with  this  observer's 
average  analysis  of  human  milk. 

The  great  advantages  of  partial  peptonization 
are  that  the  necessity  for  lime-water,  barley-water, 
and  thickening  substances  to  keep  apart  the  curd 
is  done  away  with,  and  that,  when  the  digestive 
disturbance  requiring  a  careful  preparation  of  food 
is  removed,  an  ordinary  milk  diet  can  be  gradually 
resumed  by  regularly  diminishing  the  time  artificial 
digestion  is  allowed  to  progress.  This  changes  the 


202  HYGIENE    OF   THE   NURSERY 

casein  in  a  less  and  less  degree,  until  finally  it  is 
taken  in  its  natural  form. 

Sometimes  milk,  in  every  form  and  however 
carefully  prepared,  disagrees,  exciting  vomiting,  or 
causing  great  flatulence  and  discomfort,  while  it 
affords  little  nourishment.  With  these  cases  and 
also  when  there  is  acute  gastric  indigestion  with 
repeated  vomiting  and  fever  or  acute  intestinal 
disturbance  with  fever,  pain,  flatulence  and  diar- 
rhoea, with  green,  liquid  movements  containing 
mucus  and  milk  curds,  the  best  plan  is  to  withhold 
milk  entirely  for  a  time  and  try  some  other  form  of 
food.  The  following  are  good  substitutes  for  an 
infant  from  three  to  six  months  old : 

1.  Albumin-water* 6-8  tablespoonfuls  (fld.  oz.  3-4). 

For  one  portion,  to  be  given  every  two  hours. 

Barley-water 6-8 tablespoonfuls  (fld.  oz.  3-4). 

Milk  sugar \  teaspoonful. 

For  one  portion,  to  be  given  every  two  hours. 

2.  Barley- jelly i  teaspoonful. 

Water 8  tablespoonfuls  (fld.  oz  4). 

Mix  and  add  half  the  white  of  a  fresh  egg. 
For  one  portion,  to  be  given  every  two  hours. 

3.  Veal-broth*  (\  Ib.  of  meat 

to  a  pint  of  water), 

Barley-water of  each,  4  tablespoonfuls  (fld.  oz.  2). 

For  one  portion,  to  be  given  every  two  hours. 

4.  Raw-beef  juice j" 1-2  teaspoonfuls. 

Exery  two  hours. 

*  See  Chapter  IX. 
•f  See  Chapter  IX. 


FOOD  203 

While  on  No.  4  the  patient  must  take  from  12  to 
24  fluidounces  of  pure  water,  barley-water,  or 
white-of-egg-  (albumin-)  water  each  twenty-four 
hours.  These  must  be  given  in  small  doses  at 
short  intervals.  For  some  time  past  I  have  almost 
abandoned  the  use  of  raw-beef  juice,  as  it  is  very 
difficult  to  obtain  fresh  beef  from  which  to  express 
it,  and  the  juice  from  cold  storage  beef  has  been 
the  apparent  cause  of  a  number  of  cases  of  ptomain 
poisoning  that  have  come  under  my  observation. 
Substitutes  that  can  be  recommended  are  Wyeth's 
Beef  Juice  and  Panopepton,  both  sterile  prepara- 
tions; of  the  former  twenty  to  thirty  drops  and  of 
the  latter  half  a  teaspoonful  about  correspond  to 
the  dose  of  raw-beef  juice  already  directed;  either 
one  should  be  diluted  with  one  or  two  teaspoonfuls 
of  cool  water. 

All  the  above  foods  are  only  to  be  used  tempo- 
rarily until  the  tendency  to  disturbance  within  the 
alimentary  canal  ceases;  then  milk  may  be  gradu- 
ally and  cautiously  resumed. 

While  the  onset  of  acute  gastric  or  intestinal 
disorders,  and  the  fact  that  the  infant  does  not 
thrive  indicate  radical  changes  in  the  food,  there 
are  other  minor  alterations  that  may  be  made  to 
meet  certain  symptoms  which  are  troublesome 
without  being  serious.  Thus,  loss  of  appetite  is 
often  due  to  overfeeding  or  to  the  presence  of  too 


204  HYGIENE   OF   THE   NURSERY 

much  fat  in  the  food  mixture,  and  is  to  be  met  by 
weakening  the  food  generally  but  especially  reduc- 
ing the  proportion  of  cream,  by  giving  water  freely 
and  by  increasing  the  intervals  between  feedings, 
but  never  by  coaxing  or  forcing  the  child  to  take 
food.  Eructation  of  small  quantities  of  food  imme- 
diately after  feeding,  results  from  the  taking  of  too 
large  quantities  or  the  too  rapid  emptying  of  the 
bottle,  or  it  may  depend  upon  too  tight  clothing  or 
upon  so  handling  the  baby,  directly  after  feeding, 
as  to  make  undue  pressure  upon  its  stomach. 
Habitual  vomiting,  or  often  repeated  regurgitation 
between  feedings,  may  be  relieved  by  reducing  the 
fat  and  increasing  the  lime-water  in  the  food,  by 
substituting  milk  sugar  for  cane  or  malt  sugar, 
and  by  feeding  at  longer  intervals.  Habitual 
flatulence  and  colic  demand  a  decrease  of  the 
sugar  and  proteids  in  the  food,  and  the  removal  of 
any  tendency  to  constipation  that  may  exist. 

Chronic  constipation  requires  an  increase  of  the 
fat,  though  care  must  be  taken  not  to  carry  this  so 
far  that  other  abnormal  conditions  result;  the  milk 
sugar  should  be  replaced  by  some  "infant  food" 
containing  maltose,  as  Mellin's  Food,  for  example, 
and  after  the  eighth  month  orange  juice  may  be 
given  once  daily  for  its  laxative  effect. 

When  infants  who  have  passed  the  first  year  be- 
come affected  with  indigestion,  it  is  often  sufficient 


FOOD  205 

* 

to  reduce  the  strength  of  the  food  to  a  point  com- 
patible with  digestive  powers.  For  instance,  at 
fourteen  months  the  food  may  be  reduced  to  that 
proper  for  a  healthy  child  of  eight  months,  or  even 
less.  At  this  more  advanced  age,  too,  predigestion 
of  the  food  is  very  serviceable. 

If  a  few  grains  of  extractum  pancreatis  be  added 
to  a  goblet  of  thick,  well-boiled  starch-gruel,  at  a 
temperature  of  100°  F.,  the  gelatinous  mucilage 
quickly  grows  thinner  and  is  soon  transformed  into 
a  fluid,  the  starch  having  been  rendered  soluble  by 
the  action  of  the  pancreatin;  by  still  longer  con- 
tact, the  hydrated  starch  is  converted  into  dextrin 
and  sugar.  Advantage  may  be  taken  of  this  prop- 
erty to  render  the  foods  containing  starch  assimi- 
lable. Thus,  to  a  mixture  of  barley-jelly  and  milk, 
e.  g.: 

Barley-jelly 2  teaspoonfuls. 

Milk  sugar i  teaspoonful. 

Warm  milk 16  tablespoonfuls  (fld.  oz.  8). 

Add  three  grains  of  extractum  pancreatis,  and  five  grains  of  bicar- 
bonate of  sodium,  and  keep  warm  for  half  an  hour  before 
administering. 

The  same  process  may  be  employed  with  food 
containing  oatmeal,  arrowroot  or  wheat  flour,  with 
a  view  of  converting  the  starchy  ingredients  into 
digestible  elements  without  materially  altering  the 
taste. 


206  HYGIENE   OF   THE   NURSERY 

When  the  infant  has  arrived  at  an  age  to  take 
meat  broths,  these  too,  when  digestion  is  enfeebled, 
may  be  readily  peptonized.* 

d.  Success  in  hand  feeding  depends  upon  proper 
administration  as  well  as  careful  preparation  of  the 
food. 

From  birth  up  to  such  time  as  broth,  bread,  and 
eggs  are  added  to  the  diet,  all  the  food  should  be 
taken  from  a  bottle.  Even  after  this,  as  the  bottle 
is  a  comfort  and  insures  slow  feeding,  it  may  be 
allowed  for  milk  preparations  until  the  child  is  four- 
teen or  fifteen  months  old,  then,  if  he  has  not  given 
it  up  of  his  own  accord,  he  must  be  weaned  from  it 
and  taught  to  drink  from  a  cup.  If  persevered  in 
much  longer  there  is  great  risk  of  the  "bottle  habit" 
being  formed,  the  child  refusing  to  take  food  except 
from  a  bottle,  and  when  finally  deprived  of  it,  will 
not  drink  milk  during  the  remainder  of  childhood, 
both  unfortunate  conditions.  If  formed,  the  habit 
must  be  broken  by  withdrawing  the  bottle  suddenly 
and  completely,  and  allowing  no  food  but  milk, 
given  from  a  cup,  until  the  child  takes  it  with 
relish.  Several  days  starvation  will  overcome  the 
difficulty,  and  no  harmful  result  need  be  feared. 
During  the  months  of  bottle  feeding  only  simple 
bottles  and  tips  are  to  be  admitted  to  the  nursery. 

*  See  Chapter  IX. 


FOOD 


207 


All  complicated  arrangements  of  rubber  and  glass 
tubing  are  not  only  an  abomination,  but  a  fruitful 
source  of  sickness  and  death.  Rather  than  use 
them,  it  is  far  better  to  feed  the  infant  with  a  spoon. 


FIG.  19. — GRADUATED  NURSING  BOTTLE. 

The  graduated  nursing  bottle  (Fig.  19),  first  sug- 
gested by  myself,  is  a  useful  implement.  Its  interior 
surface  is  so  shaped  as  to  present  no  angles  for  the 
collection  of  milk;  it  is  easily  cleaned,  and  the 


208  HYGIENE    OF   THE   NURSERY 

graduated  scale  is  convenient  for  nursery  use.  It  is 
made  of  transparent  flint  glass,  so  that  the  slightest 
foulness  can  be  detected  at  a  glance,  and  varies 
in  capacity  from  six  to  twelve  fluidounces.  The 
modern  cylindrical,  graduated  bottle  is  even  more 
readily  kept  clean,  and  is  to  be  recommended.  The 
number  of  bottles  in  use  should  exceed  by  one  or  two 
the  number  of  daily  feedings,  the  extra  ones  being 
on  hand  in  case  of  accident.  Imme- 
diately after  a  meal,  the  bottle,  if  not 
drained  by  the  infant,  is  emptied  of 
whatever  quantity  of  food  it  contains, 
thoroughly  washed  out  with  cold 
water,  filled  with  a  solution  of  bicar- 

FlG.    2O.  -  r  T 

BOTTLE  TIP.  bonate  of  sodium — one  teaspoonful  to 
a  pint  of  water — and  placed  out  of 
the  way  in  some  convenient  place;  in  the  morning, 
before  filling,  all  the  bottles  are  carefully  washed 
with  hot  soap  suds  and  a  bottle  brush,  and  finally 
sterilized  by  immersion  in  boiling  water  for  twenty 
minutes. 

The  tips  or  nipples,  of  which  there  should  also  be 
several,  must  be  composed  of  soft,  flexible  India- 
rubber,  and  a  conical  shape  is  to  be  preferred,  as 
being  more  readily  everted  and  cleaned;  the  open- 
ing at  the  point  must  be  free,  but  not  large  enough 
to  permit  the  milk  to  flow  in  a  stream  without 
suction.  At  the  end  of  each  feeding  the  nipple  must 


FOOD  209 

be  removed  at  once  from  the  bottle,  cleansed  exter- 
nally by  rubbing  with  a  stiff  brush  wet  with  warm 
water  and  borax,  everted  and  treated  in  the  same 
way,  and  then  placed  in  a  covered  jar  containing 
boric  acid  solution,  freshly  made  each  day,  and 
allowed  to  stand  in  a  cool  place  until  again  wanted. 
When  the  bottles  are  being  sterilized,  the  tips  should 
be  placed  in  boiling  water  for  five  minutes,  and  just 
before  one  is  used  it  should  be  dipped  in  hot  water. 
Sometimes  it  is  important  to  separately  prepare 
each  feeding  just  before  it  is  given,  but,  as  a  rule, 
it  is  quite  safe,  more  accurate  and  much  less  trouble- 
some to  make  the  whole  day's  supply  of  food  as  soon 
as  possible  after  the  milk  has  been  served  in  the 
morning.  In  making  the  mixture  the  required 
quantity  of  boiled  water  is  measured  in  a  glass 
graduate  and  poured  into  a  large  clean  vessel,  the 
milk  sugar  is  then  added  and  dissolved,  then  the 
cream  and  milk,  all  carefully  measured,  and  the 
whole  thoroughly  mingled  by  stirring.  Next  the 
prescribed  quantity  for  each  meal  is  poured  into 
separate  bottles,  and  these  being  carefully  stopped 
with  cotton,  are  placed  in  the  nursery  refrigerator 
until  wanted.  When  feeding  time  arrives  a  bottle 
is  taken  from  the  ice  and  the  food  heated  to  a  tem- 
perature of  about  98°  F.  This  is  done  by  steeping 
the  bottle  in  hot  water,  or  by  placing  it  in  a  water- 
bath  over  an  alcohol  lamp  or  gas  jet.  Finally,  re- 
14 


210  HYGIENE   OF   THE   NURSERY 

move  the  cotton  stopper,  apply  the  tip,  and  the  meal 
is  ready.  To  determine  that  the  food  is  of  the  right 
temperature  for  the  infant  to  take,  one  must  use  a 
thermometer,  or  shake  a  few  drops  from  the  bottle 
upon  the  inner  side  of  the  wrist  where  it  should 
feel  only  warm;  under  no  circumstances  should  it 
be  tested  by  inserting  the  tip  into  the  nurse's  or 
mother's  mouth. 

The  separate  preparation  of  each  feeding  is  to 
be  recommended  during  the  first  week  of  life;  in 
cases  that  are  difficult  to  feed;  when  whey  mixtures 
are  used,  and  when  peptogenic  milk  powder  is 
employed  and  it  is  desirable  to  continue  the  diges- 
tive action  of  the  pancreatin  while  the  food  is  passing 
through  the  gastro-intestinal  canal.  In  following 
this  plan,  some  minutes  before  each  feeding  hour, 
so  as  to  avoid  hurry,  measure  the  different  fluid 
ingredients  of  the  food  in  the  graduated  bottle  or 
glass,  add  the  requisite  quantity  of  milk  sugar, 
mix  thoroughly  by  shaking  or  by  stirring  with  a 
spoon,  and  heat  as  before. 

When  feeding,  the  child  must  occupy  a  half- 
reclining  position  in  the  nurse's  lap.  The  bottle 
should  be  held  by  the  nurse,  at  first  horizontally, 
but  gradually  more  and  more  tilted  up  as  it  is  emp- 
tied, the  object  being  to  keep  the  neck  always  full 
and  prevent  the  drawing  in  and  swallowing  of  air. 
Ample  time,  say  five,  ten  or  twenty  minutes,  accord- 


FOOD  211 

ing  to  the  quantity  of  food,  should  be  allowed  for 
the  meal.  It  is  best  to  withdraw  the  bottle  occa- 
sionally for  a  brief  rest,  and  after  the  meal  is  over, 
sucking  from  the  empty  bottle  must  not  be  allowed 
even  for  a  moment. 

e.  For  children  residing  in  cities,  an  honest 
dairyman  must  be  found  who  will  serve  sound 
milk  and  cream  from  country  cows  once  every  day 
in  winter,  and  twice  during  the  day  in  the  heat  of 
summer.  The  farm  should  be  so  situated  that  the 
consumer  may  be  served  not  later  than  twelve  hours 
after  milking.  The  milk  of  ordinary  stock  is  more 
suitable  than  that  from  Alderney,  Durham,  or  fancy- 
bred  cows,  as  in  these  the  fat  percentage  is  either 
too  low  or  too  high,  varying  from  2.88  to  5.21  per 
cent.  The  mixed  milk  of  a  good  herd  is  to  be  pre- 
ferred to  that  from  a  single  animal.  It  is  less  likely 
to  be  affected  by  peculiarities  of  feeding,  and  less 
liable  to  variation  from  alterations  in  health  or 
different  stages  of  lactation. 

The  care  of  the  herd  and  of  the  milk  is  of  great 
consequence.  The  cows  should  be  subjected  to  the 
tuberculin  test,  their  condition  of  health  should 
be  guaranteed  by  careful  and  regular  inspection 
by  a  competent  veterinarian,  and  the  milk  of  any 
animal  failing  to  pass  should  not  be  mixed  with 
that  from  healthy  animals.  The  cows  must  not  be 
fed  upon  swill  or  the  refuse  of  breweries,  glucose 


212  HYGIENE   OF   THE   NURSERY 

factories,  or  any  other  fermented  food.  They  must 
not  be  allowed  to  drink  stagnant  water,  and  must 
not  be  heated  or  worried  before  being  milked.  The 
pasture  must  be  free  from  noxious  weeds,  and  the 
barn  and  yard  and  the  animals  themselves  must  be 
neat.  The  udder  should  be  washed  before  the  milk- 
ing, and  the  milkers  and  dairy  workers  should  be 
healthy  and  their  hands  and  clothing  should  be  kept 
clean.  At  the  same  time  careful  aseptic  precau- 
tions must  be  observed  with  cans,  pails,  and  every 
implement  with  which  the  milk  comes  in  contact. 

The  milk  must  be  at  once  thoroughly  cooled. 
This  is  best  accomplished  by  placing  the  can  in  a 
tank  of  cold  spring-water,  or  in  ice-water,  the  water 
being  of  the  same  depth  as  the  milk  in  the  can.  It 
is  well  to  keep  the  water  in  the  tank  flowing;  in- 
deed, this  is  necessary  unless  ice-water  be  used. 
The  can  should  remain  uncovered  during  the  cooling 
and  the  milk  should  be  gently  stirred.  The  tem- 
perature should  be  reduced  to  45°  F.  within  an  hour, 
and  the  can  must  remain  in  the  cold  water  keeping 
the  milk  at  50°  F.  until  the  time  for  delivering. 

In  summer,  when  ready  for  delivery,  the  top 
should  be  placed  in  position  and  a  cloth  wet  in  cold 
water  spread  over  the  can,  or  refrigerator  cans  may 
be  used.  At  no  season  should  the  milk  be  frozen, 
and,  on  the  other  hand,  no  buyer  should  receive 
milk  having  a  temperature  over  65°  F. 


FOOD  213 

The  plan  of  "bottling"  cow's  milk  and  serving 
n  glass  jars  having  air-tight  tops  is  very  much  better, 
and  has  been  adopted  almost  uniformly,  now  that 
the  importance  of  securing  a  pure  milk  supply  for 
infants  has  been  recognized  and  insisted  upon.  The 
milk  so  delivered  should  be  kept  at  a  temperature 
of  50°  F.  by  placing  the  jars  in  a  refrigerator  until 
the  time  comes  to  make  up  the  daily  food  mixture. 
When  the  milk  and  cream  are  not  served  in  sealed 
glass  jars,  it  is  well  to  provide  two  sets  of  small  cans, 
one  set  to  be  thoroughly  cleansed  and  sterilized  by 
boiling  water  while  the  other  is  taken  away  by  the 
milkman  to  bring  back  the  next  supply.  When  this 
arrives  in  the  morning,  or  in  the  morning  and 
evening  in  hot  weather,  the  milk  should  be  strained 
through  a  thick  layer  of  absorbent  cotton,  or  cheese 
cloth,  into  separate  and  absolutely  clean  earthenware 
or  glass  vessels  with  secure  tops,  and  these  put  at 
once  into  a  refrigerator  reserved  exclusively  for 
them.  This  may  stand  in  some  convenient  spot 
near  the  nursery,  but  not  in  it,  and  especially  not 
in  an  adjoining  bath-room.  With  a  good  refrig- 
erator there  is  no  difficulty  in  keeping  milk  at  about 
50°  F.  and  perfectly  sweet  for  twenty-four  hours  in 
winter  and  for  twelve  hours  in  summer,  except  on 
intensely  hot  days;  then  it  may  be  necessary  to 
Pasteurize  the  whole  of  the  supply  when  received, 
in  order  to  prevent  change. 


214  HYGIENE    OF   THE   NURSERY 

As  milk  exists  in  the  healthy  cow's  udder  it  is 
aseptic,  but  during  milking  and  subsequent  hand- 
ling and  transportation  it  often  becomes  contami- 
nated by  various  foreign  materials,  both  organic  and 
inorganic,  which  either  are  apt  to  set  up  some  in- 
jurious change  in  the  fluid  before  ingestion,  or  give 
rise  to  various  disturbances  after  entering  the  ali- 
mentary canal.  Again,  if  the  cows  themselves  be 
unhealthy,  their  milk  may  carry  disease  germs. 
The  germs  most  frequently  present  are  the  bacteria 
potent  in  the  production  of  diarrhceal  disorders; 
the  bacillus  tuberculosis;  and  the  germs  of  cholera, 
diphtheria,  scarlet  and  typhoid  fevers,  all  of  which 
are  readily  taken  up  by  and  flourish  in  milk  at 
ordinary  temperatures.  To  deprive  these  acciden- 
tally introduced  organic  impurities  of  their  activ- 
ity the  milk  must  be  subjected  to  sterilization. 
It  must  be  insisted  here  that  this  process  is  a  pre- 
ventive, and  in  no  sense  a  therapeutic  measure; 
that  it  is  not  to  be  recommended  when  one  can  be 
sure  of  the  purity  of  the  milk  supplied  and  of  the 
conditions  for  its  preservation;  and  that  milk  so 
treated  must  be  modified  according  to  the  age  and 
demands  of  the  individual  case  in  the  usual  way. 
Sterilization  may  be  conducted  either  at  a  high  or 
low  temperature. 

Sterilization  at  a  High  Temperature  (212°  F). — 
Several  admirable  implements  have  been  devised 


FOOD 


215 


for  conducting  the  process;  one  of  the  most  simple, 
made  after  a  design  by  the  author,  is  shown  in 
Fig.  21. 

This  apparatus  is  made  of  tin,  and  consists  of  an 
oblong  case  provided  with  a  well-fitting  cover,  and 
having  a  movable  perforated  false  bottom  (D), 


FIG.  21. — AUTHOR'S  STERILIZER. 

which  stands  a  short  distance  above  the  true  one 
and  has  attached  a  framework  capable  of  holding 
ten  six-ounce  nursing  bottles.  On  the  outside  of 
the  case  is  a  row  of  supports  (B)  for  holding  bottles 
inverted  while  drying,  and  at  the  proper  distance 
below  these  a  gradually  inclining  gutter  (c)  for 


2l6         HYGIENE  OF  THE  NURSERY 

carrying  off  the  drip.  A  movable  water-bath  (A) 
is  hung  to  the  side;  in  this  each  bottle  of  food  may 
be  heated  at  the  time  of  administration. 

The  bottles  are  made  of  flint  glass  and  are  gradu- 
ated; the  graduated  markings  being  especially 
convenient  for  measurement  and  rendering  the 
use  of  a  separate  measuring-glass  unnecessary,  a 
matter  of  no  little  moment,  as  every  implement 
that  comes  in  contact  with  the  milk  in  sterilization 
must  be  kept  chemically  clean.  Ten  bottles  are 
used,  so  that  the  whole  supply  of  milk  intended  for 
a  day's  consumption  can  be  prepared  at  once. 
Each  bottle  is  provided  with  a  perforated  rubber 
cork,  which  in  turn  is  closed  by  a  well-fitting  glass 
stopper. 

Sterilization  should  be  performed  in  the  morning 
as  soon  as  possible  after  the  milk  has  been  delivered. 
The  process  is  as  follows:  First,  see  that  the  ten 
bottles  are  perfectly  clean  and  dry;  pour  into  each 
six  fluidounces  (12  tablespoonfuls)  of  milk;  insert 
the  perforated  rubber  corks,  without  the  glass  stop- 
pers, however;  remove  the  false  bottom  and  place 
the  bottles  in  the  frame;  pour  into  the  case  enough 
water  to  fill  it  to  the  height  of  about  two  inches;  re- 
place the  false  bottom  carrying  the  bottles;  adjust 
lid,  and  put  the  whole  on  the  kitchen  range.  Allow 
the  water  to  boil,  and,  by  occasionally  removing  the 
lid,  ascertain  that  the  expansion  that  immediately 


FOOD  217 

precedes  boiling  has  taken  place  in  the  milk;  then 
press  the  glass  stoppers  into  the  perforated  corks, 
and  thus  hermetically  close  each  bottle.  After 
this,  keep  the  apparatus  on  the  fire  and  the  water 
boiling  for  twenty  minutes.  Finally,  remove  the 
false  bottom  with  the  bottles;  pour  out  the  water, 
replace,  and  carry  the  whole,  covered  with  the  lid, 
to  the  nursery. 

When  the  hour  of  feeding  arrives,  put  one  of  the 
bottles  into  the  attached  water-bath  and  heat  it  to 
the  proper  point  for  administration.  The  milk 
must,  of  course,  be  diluted  with  filtered  water,  and 
receive  the  additions  ordinarily  made  to  adapt  it  to 
children  of  different  ages.  The  tip  used — and  a 
tube  must  not  be  employed  even  here — should  be 
thoroughly  cleaned,  and  immersed  for  a  few  mo- 
ments in  boiling  water  before  it  is  attached  to  the 
bottle. 

As  soon  as  a  bottle  is  emptied — and  if  the  whole 
of  its  contents  be  not  taken,  the  remainder  must  be 
thrown  away — it  is  washed  in  the  ordinary  manner 
with  a  solution  of  bicarbonate  of  sodium  (one  tea- 
spoonful  to  a  pint  of  water)  and  placed  in  the  rack 
(B)  to  drain  and  dry. 

Milk  sterilized  by  the  above  process  will  remain 
sound  for  several  days — according  to  some  author- 
ities, as  many  as  eighteen — when  the  heating  is  con- 
tinued for  thirty  minutes,  and  still  longer  if  pro- 


2l8  HYGIENE   OF   THE   NURSERY 

tracted  for  an  hour  and  a  half.  It  is  especially 
useful  in  traveling,  when  fresh  milk  cannot  be 
obtained;  for  use  in  cities  during  the  heat  of  summer, 
when  milk  is  most  apt  to  undergo  injurious  changes; 
for  a  temporary  change  of  food  for  delicate  children, 
or  for  those  suffering  from  diseases  of  the  stomach 
or  intestinal  canal.  But  the  experiments  of  Leeds 
show  that  sterilization  at  the  boiling-point  of  water 
causes  the  following  modifications:  Casein  is  ren- 
dered less  coagulable  by  rennet,  and  is  acted  on 
slowly  and  imperfectly  by  pepsin  and  pancreatin; 
proteid  matters  attach  themselves  to  fat  globules, 
and  probably  bring  about  a  less  perfect  assimilation 
of  fat;  while  milk  sugar,  by  prolonged  heating,  is 
completely  destroyed.  Koplik  states  that  "from 
the  temperature  of  167°  F.  upwards,  there  is  a  sepa- 
ration of  the  serum-albumin  of  the  milk;  the  casein 
loses  its  coagulability  to  rennet,  and  at  185°  F. 
amounts  of  rennet  which  for  the  raw  condition  of 
the  milk  are  found  sufficient  to  act,  cease  to  be 
effective."  On  account  of  these  alterations  milk 
sterilized  at  a  high  temperature  is  difficult  to  digest, 
and  many  infants  do  not  thrive  upon  it,  become 
constipated,  are  badly  nourished  and  anaemic,  and 
often  develop  scurvy;  hence  the  process  should  never 
be  resorted  to  except  as  a  temporary  expedient. 

The  problem,  therefore,  that  presents  itself  in 
the  sterilization  of  milk  for  infants'  food  is  to  devise 


FOOD  219 

a  method  which  shall  efficiently  destroy  the  con- 
tained germs,  and  yet  in  the  least  possible  degree 
interfere  with  its  ready  digestion  and  its  nutritive 
qualities.  This  is  best  accomplished  by: 

Sterilization  at  a  low  temperature,  or  Pasteuriza- 
tion.— Hueppe  considers  that  from  a  physiological 
standpoint  milk  is  best  sterilized  under  a  tempera- 
ture of  167°  F.,  while  other  experimenters  have 
shown  that  temperatures  lower  than  212°  F.,  if 
continued  for  a  short  time,  will  destroy  a  very  large 
proportion  of  the  germs,  and  will  destroy  with 
certainty  many  pathogenic  germs  which  find  their 
way  into  milk  either  from  the  cow  or  as  external 
contaminations.  The  elaborate  experiments  of 
Yersin,  Granchier,  Lidoux-Libard,  and  Bitter 
show  that  the  bacillus  tuberculosis  in  milk  will  be 
destroyed  in  ten  minutes  by  an  exposure  to  167°  F., 
in  fifteen  minutes  to  158°  F.,  and  in  thirty  minutes 
to  154.5°  F.  Concerning  other  bacteria,  Van 
Geuns  found  that  a  few  seconds'  exposure  to  140°  F. 
would  kill  the  cholera  spirilla,  the  typhoid  bacillus, 
and  the  pneumococcus. 

It  may,  therefore,  be  concluded  that  a  tempera- 
ture of  155°  to  1 60°  F.  maintained  for  thirty  minutes 
will  render  milk  sufficiently  germ-free  for  infant 
food.  It  is  also  certain  that  a  temperature  of  less 
than  176°  F.  produces  no  alterations  in  the  composi- 
tion of  milk  that  affect  its  digestibility. 


220  HYGIENE    OF    THE   NURSERY 

Methods  of  Pasteurizing  milk  in  bulk  have  been 
brought  forward  both  in  Germany  and  in  this 
country,  and  now  the  procedure  has  been  reduced 
to  an  easily  managed  system  for  household  use. 
This  depends  upon  the  fact  that  the  temperature 
of  the  milk  to  be  treated  may  be  raised  to  about 
the  desired  point  (i55°-i6o°  F.)  by  immersing  a 
certain  definite  quantity  of  milk  in  a  properly 
porportioned  bulk  of  boiling  water,  the  source  of 
heat  having  been  removed.  A  convenient  appa- 
ratus for  nursery  use  is  Dr.  Freeman's  Pasteurizer 

(Fig.   22). 

The  apparatus  consists  of  a  pail  for  water  and  a 
receptacle  for  the  bottles  of  milk.  The  pail  is  a 
simple  affair  with  a  cover.  Extending  around  it  is 
a  groove  for  indicating  the  level  to  which  it  is  to  be 
filled  with  water;  inside  are  three  supports  (c)  for 
holding  the  receptacle.  The  receptacle  for  the  bot- 
tles consists  of  a  number  of  hollow  cylinders  fastened 
together  and  surrounded  by  a  wire  (A),  which  rests 
on  the  support  (c)  when  the  milk  is  being  heated. 
Below  the  wire  (A)  are  three  short  wires  (B);  these 
rest  on  the  supports  (c)  when  the  receptacle  is  raised 
for  cooling.  The  steps  of  the  process  are  as  fol- 
lows: 

Fill  the  pail  to  the  level  of  the  groove  with  water, 
cover  it,  and  put  it  on  the  stove  to  boil,  the  receptacle 
for  the  bottles  having  been  left  out.  Fill  the  body 


FOOD 


221 


of  each  bottle  with  milk  or  some  modification  of 
milk   in   proper   proportion   for   feeding;    stopper 


with  a  wad  of  cotton-batting  and  put  in  a  refrig- 
erator. If  all  the  bottles  which  the  receptacle  holds 
are  not  needed,  fill  the  remaining  cylinders  with 


222  HYGIENE    OF   THE   NURSERY 

cold  water.  When  the  water  in  the  pail  on  the 
stove  boils  thoroughly,  take  the  bottles  of  milk 
from  the  refrigerator  and  put  them  in  the  spaces 
in  the  receptacle.  Pour  cold  water  into  each  of 
these  spaces  so  as  to  surround  the  body  of  the  bottle. 
Take  the  pail  of  boiling  water  from  the  stove  and 
put  it  on  a  table  or  mat,  not  on  metal  or  stone. 
Be  sure  that  the  pail  is  still  filled  exactly  to  the  level 
of  the  groove  and  that  the  water  is  boiling  vigorously. 
Put  the  receptacle  containing  the  bottles  of  milk 
into  the  pail  of  boiling  water,  so  that  the  wire  (A) 
will  rest  on  the  support  (c) ;  cover  the  pail  quickly 
and  let  it  stand  thirty  minutes.  During  this  period 
the  pail  must  not  be  on  the  stove  and  the  cover 
must  not  be  removed.  Now  uncover  the  pail  and 
lift  the  receptacle  and  turn  it  so  that  the  wire  (B) 
will  rest  on  the  support  (c),  thus  elevating  the 
top  of  the  receptacle  above  that  of  the  pail.  Put 
the  whole  in  a  basin  under  a  faucet  to  which  a  rubber 
pipe  may  be  attached  connecting  it  with  the  pail. 
The  water  will  overflow  from  the  pail  into  the  basin. 
Or  the  pail  may  be  placed  under  a  pump,  fresh 
cold  water  being  pumped  into  it  every  few  minutes. 
When,  however,  it  is  not  possible  to  cool  the  milk 
in  this  way,  place  the  receptacle  containing  the 
bottles  in  iced  water,  or  stand  the  bottles  on  wood 
in  a  refrigerator.  To  warm  the  milk  for  use,  put 
the  bottle  containing  it  in  a  vessel  of  cold  water  on 


FOOD  223 

the  stove,  and  leave  it  until  it  is  warm.  Use  a  fresh 
bottle  for  each  feeding.  Wash  the  bottles  thor- 
oughly after  using,  and  once  a  day  put  all  the 
empty  bottles  in  a  kettle  of  cold  water  on  the  stove 
and  let  this  water  boil  for  an  hour.  The  bottles 
should  then  be  taken  out  and  placed  bottom  up 
until  used. 

A  sufficiently  perfect  apparatus  may  be  readily 
improvised.  All  that  is  required  is  a  bottle-rack 
similar  to  that  of  the  Arnold  sterilizer,  and  a  tin 
pail  large  enough  to  receive  the  rack  and  bottles 
and  provided  with  a  well-fitting  cover.  In  con- 
ducting the  process  fill  the  bottles,  previously  per- 
fectly cleaned,  with  milk  and  stop  them  with  cot- 
ton; place  them  in  the  rack,  and  this  in  turn  in 
the  pail;  pour  into  the  pail  enough  boiling  water  to 
come  up  to  the  level  of  the  milk  in  the  bottles;  adjust 
the  cover,  and  let  the  whole  stand  on  a  wooden 
table  until  the  water  becomes  cool — twenty  to 
thirty  minutes;  lastly,  cool  the  milk  quickly  by 
placing  the  bottles  in  ice-water  for  fifteen  or  twenty 
minutes  and  then  transfer  to  the  refrigerator.  The 
importance  of  immediate  and  quick  cooling  and 
of  refrigeration  after  Pasteurization  cannot  be  too 
strongly  insisted  upon,  for  if  the  milk  be  allowed 
to  remain  warm,  or,  being  left  about  carelessly, 
again  becomes  warm  after  the  sterilization,  any 
germs  that  may  find  entrance  multiply  even  more 


224  HYGIENE    OF   THE   NURSERY 

rapidly  than  in  raw  milk  and  it  quickly  becomes  a 
more  dangerous  food  than  if  it  had  never  been 
subjected  to  the  process.  The  mother  must  re- 
member that  Pasteurization  is  nev.er  to  be  employed 
when  clean  milk  can  be  obtained;  that  its  object  is 
simply  to  render  dirty  milk  safe,  and  that  it  does 
not  insure  against  further  deterioration  or  do  away 
with  the  necessity  of  keeping  the  milk  properly 
iced,  and  of  securely  stopping  the  bottles  with  cot- 
ton to  prevent  the  re-entrance  of  germs.  When 
thus  carefully  handled,  pasteurized  milk  will  keep 
perfectly  sound  and  sweet  for  twenty-four  hours 
at  least.  Its  advantage  as  a  food  lies  in  its  sterility, 
and,  like  ordinary  milk,  it  must  be  modified  by 
the  addition  of  water,  cream,  and  milk  sugar  to 
meet  the  special  demands  of  each  case. 

The  various  milk  mixtures  are  often  Pasteurized, 
the  method  being  the  same  as  for  pure  milk. 

Childhood. — Children  who  have  cut  their  milk 
teeth  may  be  fed  for  a  twelvemonth — namely,  up  to 
the  age  of  three  and  a  half  years — as  follows: 

First  meal,  7  A.M. — One  or  two  tumblerfuls  of  milk, 
a  saucer  of  thoroughly  cooked  oatmeal  or  wheaten 
grits  with  cream  and  salt,  and  a  slice  or  two  of  bread 
and  butter. 

Second  meal,  n  A.M.  (if  hungry). — A  tumblerful 
of  milk  or  a  teacupful  of  broth  with  a  biscuit. 

Third  meal,  2  P.M. — A  slice  of  underdone  roast 


FOOD  225 

beef  or  mutton,  or  roast  chicken  or  turkey,  minced 
as  fine  as  possible;  a  baked  potato  thoroughly 
mashed  with  a  fork  and  moistened  with  gravy,  or  one 
well-cooked  green  vegetable,  as  spinach,  young  peas 
mashed  with  a  fork,  or  stewed  celery,  and  bread  and 
butter;  a  saucer  of  junket  or  rice-and-milk  pudding. 

Fourth  meal,  7  P.M. — A  tumblerful  of  milk  and 
one  or  two  slices  of  well-moistened  milk  toast. 

Orange-juice,  apple  scraped  with  a  spoon,  ripe 
peaches,  and  cooked  fruit  not  oversweetened,  may 
be  allowed,  especially  if  there  be  a  tendency  to 
constipation. 

From  three  and  one-half  years  up  the  child  must 
take  his  meals  at  the  table  with  his  parents,  or  with 
some  reliable  attendant  who  will  see  that  he  eats 
leisurely.  The  heaviest  meat  must  be  given  at  mid- 
day, the  supper  must  always  be  light,  plenty  of 
water  should  be  taken  between  meals  and  but  little 
with  food,  and  in  some  delicate  children,  up  to  the 
eighth  year,  a  glass  of  milk  may  be  allowed  between 
breakfast  and  dinner.  The  food,  while  plain,  must 
be  varied,  and  may  be  selected  from  the  following 
articles: 

MILK. — Quantity  required,  from  one  and  a  half  to  two  pints  daily, 
including  what  the  child  drinks  and  takes  with  cereals  and  in 
cooked  food.  It  must  be  clean  and  fresh,  not  overrich  in  fat; 
cream  to  be  used  sparingly.  Milk  must  not  be  given  with 
dinner,  or  when  acid  fruits  are  eaten.  Butter,  fresh  and 
preferably  unsalted,  in  moderate  quantities  and  on  bread. 
15 


226  HYGIENE   OF   THE   NURSERY 

CEREALS. — Coarse  ground  cereals  are  best,  oatmeal,  cracked 
wheat,  hominy  grits;  these  must  be  soaked  overnight,  and 
cooked  for  three  hours  in  a  double  boiler.  The  prepared 
flours,  corn  starch,  arrow-root,  barley,  must  be  cooked  at  least 
half  an  hour.  Serve  with  cream,  or  milk  and  cream,  and  salt; 
sugar  as  little  as  possible,  one-half  teaspoonful  at  most,  no 
syrup,  or  butter  and  sugar.  Never  give  ready-to-serve  cereals . 

EGGS. — Best  with  breakfast.  Should  be  fresh  and  lightly  and 
plainly  cooked,  soft  boiled,  poached,  coddled,  scrambled  or  plain 
omelet. 

MEAT. — Give  at  mid-day  meal.  Should  be  broiled  or  roasted, 
never  fried;  and  either  scraped  or  cut  up  very  fine.  Choose 
chicken,  lamb,  mutton  chops,  tender  beefsteak  or  roast  beef. 
Avoid  ham,  sausage,  pork  (bacon  may  be  taken),  liver,  kidney, 
cold  storage  or  hung  game  and  all  dried  or  salted  meats.  Dish 
gravy  from  roast  beef  or  beefsteak  good,  but  made  gravies  are 
to  be  forbidden. 

FISH. — Must  be  fresh  and  boiled  or  baked,  never  fried.  Those 
that  are  delicate,  i.e.,  free  from  oil  with  firm  short  fibered  flesh 
should  be  selected,  as  bass,  perch,  trout,  flounder,  sole,  white 
fish.  Avoid  shad,  smelts,  salmon,  cod,  mackerel  and  halibut. 
Oysters  can  be  given,  using  the  soft  parts  only,  lightly  and  plainly 
stewed.  Other  shell-fish  forbidden. 

VEGETABLES. — White  potato,  baked  or  boiled  and  mashed,  is 
the  first  vegetable  to  be  given,  serve  with  roast  beef  gravy  or 
cream,  not  butter.  Baked  sweet  potato  may  be  given'later.  Best 
green  vegetables  are  peas,  spinach,  asparagus  tips,  string-beans, 
celery  (stewed),  young  beets  or  carrots,  squash.  As  age  ad- 
vances onions  (boiled),  turnips,  cauliflower  and  tomato  (baked). 
Canned  peas  and  asparagus  tips  can  be  used.  Avoid  corn,  lima 
beans  (except  when  very  young  and  tender),  cabbage,  eggplant, 
and  raw  vegetables,  as  celery,  radishes,  onion  or  cucumber. 
All  green  vegetables  must  be  thoroughly  cooked,  mashed  and 
strained  through  a  coarse  sieve.  The  appearance  of  small 
particles  of  vegetable  matter  in  the  bowel  evacuations  does  not 
mean  a  discontinuance  of  the  vegetable,  but  simply  its  longer 
cooking  and  finer  mashing  and  straining. 


FOOD  227 

SOUPS. — Meat  broths  better  for  children  than  vegetables,  though 
after  the  eighth  year  purees  of  peas,  spinach,  celery  or  asparagus 
may  be  used.  Of  the  meat  broths,  mutton  and  chicken  are 
the  best,  these  may  be  given  plain  or  thickened  with  rice  or  barley, 
and  the  time  to  serve  them  is  at  the  mid-day  meal. 

BREAD. — The  best  are  ordinary  wheat,  bran  or  whole- wheat  bread; 
stale,  cut  thin  and  newly  dried  crisp  in  the  oven.  Oatmeal, 
graham  or  whole- wheat  crackers,  unsweetened  Zwieback,  and 
corn  bread,  split  and  dried  crisp  or  toasted  are  to  be  given  for 
variety.  Fresh  bread,  hot  bread  and  fresh  rolls  must  be  avoided . 
As  to  cake,  stale  sponge  cake  or  lady-fingers  only  are  allowable, 
and  never  fresh  sweet  cakes,  especially  those  that  are  iced  or 
contain  dried  fruit.  Buck-wheat  and  other  griddle  cakes  also 
come  under  the  ban. 

DESSERTS. — Junket,  plain  rice-and-milk  pudding,  a  simple 
custard,  and  once  a  week  a  little  vanilla  or  chocolate  ice  cream 
are  the  only  made  desserts  to  be  allowed  during  childhood. 
Never  give  even  a  taste  of  pie,  tart  or  pastry,  jam,  preserved 
fruits,  nuts,  candy  or  dried  fruits. 

FRUITS. — These  are  dietetically  important  and  should  be  begun 
hi  infancy,  as  they  have  a  particularly  good  effect  in  main- 
taining the  activity  of  the  bowels.  They  should  be  carefully 
selected  and  used  in  moderation,  especially  with  city  children 
and  in  hot  weather.  Up  to  the  sixth  year,  cooked  fruit,  and 
fruit  juices  are  given.  The  best  cooked  fruits  are  apples,  baked 
or  stewed,  and  stewed  prunes  and  peaches,  little  sugar  being 
used.  Of  fruit  juices,  that  from  fresh  sweet  oranges  is  to  be 
preferred,  but  the  fresh  juice  of  grape-fruit,  grapes,  peaches 
and  pineapple  may  be  used.  The  pulp  of  oranges  and  grape- 
fruit must  not  be  given,  but  that  from  apples,  obtained  by 
scraping  with  a  spoon,  is  very  useful.  Older  children  may  eat 
oranges,  grape-fruit,  peaches,  plums,  apples,  pears,  grapes,  very 
ripe  cherries,  cantaloupes,  and,  sometimes,  strawberries,  but  the 
other  fruits  with  small  seeds,  had  best  be  avoided,  so  also 
watermelon  and  apricots.  Whether  bananas  can  be  given  is 
a  matter  of  trial,  some  children  being  able  to  eat  them  with 
advantage,  others  quite  the  reverse.  Fruit,  especially  if  acid, 


228  HYGIENE   OF   THE   NURSERY 

should  not  be  eaten  close  to  a  meal  at  which  milk  is  taken.  If 
its  laxative  effect  be  desired,  and  in  infants,  fruit  juice  is  best  given 
before  the  first  meal  in  the  morning,  or  midway  between  two 
of  the  earlier  feedings.  In  older  children  fruit  is  usually  eaten 
as  a  dessert  after  the  midday  meal,  though  cooked  fruit  may 
be  perfectly  safely  taken  with  the  supper,  which  it  serves  well  to 
fill  out.  Children  should  eat  fruit  with  the  least  possible  sugar, 
and,  always,  without  milk  or  cream,  and  must  abandon  it  entirely 
should  it  produce  looseness  of  the  bowels  with  mucous  evacua- 
tions and  abdominal  pain. 

DRINK. — Water  only  during  earlier  childhood,  later  cocoa  made 
almost  entirely  of  hot  milk.  Never  tea,  coffee,  wine,  beer  or 
other  alcoholic  beverage,  in  any  form  or  smallest  quantity. 

The  following  list  will  give  an  idea  of  the  arrange- 
ment of  the  meals: 

BREAKFAST. 

EVERY  DAY.  ONE  DISH  ONLY  EACH  DAY. 

Milk.  Fresh  fish.  Eggs,  scrambled. 

Porridge  and  cream.    Eggs,  lightly  boiled.  Eggs,  plain  omelet. 
Bread  and  butter.        Eggs,  poached.          Bacon. 

Sound  fruits  may  be  allowed  before  and  after  the  meal,  according 
to  taste,  as  oranges,  grapes  without  pulp  (seeds  not  to  be  swallowed), 
peaches,  thoroughly  ripe  pears,  cantaloupes,  and  sometimes 
strawberries. 

DINNER. 

EVERY  DAY.  Two  DISHES  EACH  DAY. 

Clear  soup.  Potatoes,  baked.  Stewed  celery. 

Meat,     roasted    or    Potatoes,  mashed.          Cauliflower, 
broiled,  and    cut    Hominy.  Peas, 

into  small  pieces.     Macaroni,  plain.  String-beans,  young. 

Bread  and  butter.        Spinach.  Nearly  all  green 

vegetables. 

Junket,  rice-and-milk  or  other  light  pudding,  and  occasionally 
ice  cream,  may  be  allowed  for  dessert. 


FOOD  229 

SUPPER. 
EVERY  DAY. 

Milk. 
Milk  toast,  or  bread  and  butter. 

Stewed  fruit,  baked  apple. 

Water — and  this  must  be  really  pure — is  to  be  taken  freely 
between  meals  and  should  be  the  only  drink;  tea,  coffee,  wine  or 
beer  being  entirely  forbidden. 

Fried  food,  highly  seasoned  or  made-up  dishes,  are  to  be 
excluded,  and  no  condiment  but  salt  is  to  be  used. 

Eating,  however  little,  between  meals  must  be 
absoutlely  avoided.  Keep  a  young  child  from 
knowing  the  taste  of  cakes  or  bonbons,  or,  having 
learned  it,  let  him  feel  that  they  are  as  unattainable 
as  the  thousand  other  things  beyond  his  reach,  and 
he  soon  ceases  to  ask  for  them.  Even  a  piece  of 
bread  between  meals  should  be  forbidden.  His 
appetite  then  remains  natural,  and  he  will  eat  proper 
food  at  his  regular  meal  hours. 

As  to  the  quantity,  a  healthy  child  may  be  per- 
mitted to  satisfy  his  appetite  at  each  meal,  under 
the  one  condition  that  he  eats  slowly  and  masticates 
thoroughly. 

In  case  of  illness,  the  diet  must  be  reduced  in 
quantity  and  quality,  according  to  the  rules  that  are 
applicable  to  adults. 


CHAPTER  IX. 

DIETARY. 

In  the  preceding  chapter  so  much  attention  has 
been  devoted  to  the  subject  of  the  artificial  feeding 
of  infants,  and  so  many  formulas  have  been  given 
for  the  modification  of  cows'  milk  as  a  substitute  for 
the  natural  food,  or  human  milk,  that  I  shall  only 
refer  here  to  a  few  milk  mixtures,  some  of  which 
have  been  recommended  by  other  writers.  After 
describing  these,  certain  methods  of  peptonization 
and  the  mode  of  preparing  a  number  of  dishes 
adapted  to  the  nursery,  whether  occupied  by  well 
or  ill  children,  will  be  discussed.  In  regard  to  the 
latter,  however,  the  dishes  that  ordinarily  come 
upon  the  table  will  not  be  referred  to,  as  any  good 
cook  ought  to  know  how  to  make  them.  Finally, 
a  series  of  diets  for  special  diseases  of  childhood 
will  be  detailed. 

MILK  AND  OATMEAL. 
Bethlehem   oatmeal    (fine 

powder) i  teaspoonful. 

Water 2  tablespoonfuls  (fld.  oz.  i  ). 

Milk 5  tablespoonfuls  (fld.  oz.  2$). 

Gravity  cream  (16%) i  tablespoonful    (fld.  oz.    i). 

Sugar  of  milk i  teaspoonful. 

230 


DIETARY  231 

Heat  the  water  just  short  of  boiling;  stir  in  the 
oatmeal  slowly  until  a  smooth  white  mixture  is 
obtained  and  boil,  in  a  double  boiler  for  twenty 
minutes;  then  add  the  other  ingredients.  For  an 
infant  of  three  months;  useful  in  constipation. 

MEIGS'  FOOD. 

Milk i  tablespoonful    (fld.  oz.    J). 

Cream 2  tablespoonfuls  (fld.  oz.  i  ). 

Lime-water 2  tablespoonfuls  (fld.  oz.  i  ). 

Milk-sugar  solution 3  tablespoonfuls  (fld.  oz.  ij). 

For  a  child  under  one  month;  quantity  to  be 
increased  as  age  advances,  but  no  change  to  be 
made  in  quality  until  after  the  eighth  or  ninth 
month. 

The  milk  sugar  solution  consists  of  17 J  drachms 
— a  little  over  17  teaspoonfuls  of  milk  sugar — to  a 
pint  of  pure  water.  This  is  the  food  recommended 
by  the  late  Dr.  A.  V.  Meigs. 

TOP  MILK  MIXTURES. 

"Top  milk"  as  ordinarily  used,  contains  7  per 
cent.  fat.  To  obtain  it  a  quart  bottle  of  milk,  just 
as  it  is  received  from  the  dairy,  is  allowed  to  stand 
in  a  refrigerator  for  four  or  five  hours,  and  then  the 
upper  portion  is  removed  by  a  cream  dipper  having 
a  capacity  of  one  ounce.  The  quantity  taken 
depends  upon  the  grade  of  the  milk;  if  poor,  the 
upper  ii  ounces  are  removed;  if  good  average 
quality,  16  ounces;  and  if  very  rich,  22  ounces. 


232 


HYGIENE  OF  THE  NURSERY 


It  is  important  to  remember  that  the  top  milk  must 
be  dipped  not  poured  off,  and  that  the  whole  quantity 
must  be  taken,  not,  only,  the  number  of  ounces 
required  to  make  any  given  mixture.  This  milk 
when  used  in  making  a  properly  combined  food 
mixture  gives  a  proportion  of  fat  to  proteids  of  2  to  i ; 
while  a  similar  combination  made  of  whole  milk, 
from  a  good  mixed  herd,  contains  equal  fat  and 
proteids  and  requires  the  adding  of  i  part  gravity 
cream  to  each  3  parts  of  whole  milk  to  make  the 
high  fat  percentage. 

High  fat  mixture  may  often  be  usefully  employed, 
especially  during  the  first  six  months  of  infancy; 
they  are  proportioned  as  follows : 


Ounces. 

Ounces. 

Ounces. 

Ounces. 

O 

Ounces. 

! 

Ounces. 

Ounces. 

Top  milk  (7%)... 

2 

3 

4 

5 

6 

7 

8 

9 

10 

Water  (boiled)  .... 

*7 

16 

15 

14 

J3 

12 

ii 

10 

9 

The  first  three  formulas  are  to  be  employed  up 
to  the  third  week  of  life;  afterward  the  strength  is 
slowly  increased  until  the  sixth  or  seventh  month, 


DIETARY 


233 


when  it  is  better  to  change  to  a  whole  milk  mixture. 
This  is  done  by  removing  more  and  more  of  the 
upper  milk;  for  example,  take  first  20  ounces  and 
then  24  from  the  quart  of  milk  and  finally  use  the 
whole  milk  well  stirred  together.  Thus: 


Milk,  4  or  5% 

Of  upper 
20  ounces 
use 
ounces  n. 

Of  upper 
24  ounces 
use 
ounces  12. 

Of  whole 
milk  use 
ounces  13. 

Milk  sugar  

ounce  i. 

ounce  i. 

ounce  i. 

Lime-water  

ounce  i.  ' 

ounce  i. 

ounce  i. 

Barley-water  

ounces  8. 

ounces  7. 

ounces  6. 

The  third  formula  should  be  reached  by  the 
ninth  month,  and,  beyond  a  gradual  increase  in 
quantity,  needs  but  small  change  during  the  rest 
of  the  first  year. 

Dr.  Joseph  E.  Winters*  employs  a  cream  food 
during  the  first  three  weeks.  Afterward  he  uses, 
for  different  ages,  a  specified  quantity  of  the  upper 
layer  dipped  from  a  quart  of  whole  milk  sixteen 
hours  after  milking,  and  modified  by  the  addition 
of  milk  sugar,  lime-water  and  filtered  water.  As 
this  scheme  of  feeding  has  proved  very  successful 
I  present  it  in  the  following  table: 

*  "Feeding  in  Early  Infancy,"  reprint  from  Medical  Record, 
March  7,  1903. 


234 


HYGIENE   OF   THE   NURSERY 

GENERAL  FORMULAS. 


Age. 

Cream. 

Upper  layer 
milk. 

Milk 
sugar. 

Lime- 
water. 

Filtered 
water. 

-(J 

Number  of 
feedings. 

ist  and  2d  days.  .  . 

i 
oz.  (a) 

3  i  tea- 
spoonfuls 

oz. 

9 
oz. 

oz. 

10 

3d  day 

it 

oz.  (b) 

spoonfuls 

oz. 

oz. 

oz. 

4th  to  7th  day  

oz.  (c) 

4  tea- 
spoonfuls 

2 

oz. 

oz. 

I 
oz. 

10 

2d  week  

2} 

oz.  (d) 

4  tea- 
spoonfuls 

2 

oz. 

10 

oz. 

I* 

oz. 

IO 

3d  week  

6 

7  tea- 

18 

oz. 

spoonfuls 

oz. 

oz. 

oz. 

4th  to  8th  week.  .  . 



9 
oz. 

8  tea- 
spoonfuls 

4 
oz. 

19 
oz. 

2* 

oz. 

10 

9th  to  1  2th  week.  . 

1  1 

7i  tea- 

8 

oz. 

spoonfuls 

oz. 

oz. 

oz. 

4th  month  . 

7  tea- 

, 

oz. 

spoonfuls 

oz. 

oz. 

oz. 

5th  and  6th  months. 



is 

oz. 

6|  tea- 
spoonfuls 

4 
oz. 

oz. 

5 
oz. 

7 

?th  to  9th  month 

e    fi 

5 

oz. 

spoonfuls 

oz. 

oz. 

oz. 

loth   and    nth 
months. 

21 
OZ. 

4*  tea- 
spoonfuls 

4 
oz. 

7 
oz. 

6 
oz. 

5 

1  2th  month  

OZ. 

z\  tea- 
spoonfuls 

4 
oz. 

3 
oz. 

6 
oz. 

5 

(a)  (6)  Dip  upper  £  ounce  from  each  of  two  quart  bottles  of  milk, 
sixteen  hours  standing.  (c)  Dip  upper  i  ounce  from  each  of  three 
quart  bottles  of  milk,  sixteen  hours  standing,  (d)  (et  seq.)  Dip  quantity 
from  one  quart  bottle  of  milk,  sixteen  hours  standing. 


Dr.  Winters  also  suggests  that  the  modifications 
employed  during  the  hot  months  of  summer  should 
be  distinctly  different  from  those  adapted  for 


DIETARY 


general  use  in  the  cooler  months, 
formulas  are  tabulated  below: 


235 
These  weaker 


SUMMER  FORMULAS. 


Age. 

Cream. 

Upperlayer 
milk. 

Milk 
sugar. 

IS 

3g 

Filtered 
water. 

Amount  at 
each  feed- 
ing. 

Number  of 
feedings. 

ist  week  

i 

3$  tea- 

ii 

9  oz. 

i-i 

10 

oz.  (a) 

spoonfuls 

oz. 

oz. 

ad  week  

oz!  (6) 

4  tea- 
spoonfuls 

2 
OZ. 

10* 

oz. 

li 

oz. 

IO 

3d  and  4th  weeks.  . 

oz2  (c) 

4  tea- 
spoonfuls 

2 
OZ. 

10 

oz. 

2-2* 
OZ. 

IO 

5th  and  6th  weeks. 

6 

7  tea- 

4 

18 

»i 

IO 

oz. 

spoonfuls 

oz. 

oz. 

oz. 

7th  week  to  end  of 
3d  month. 

9 
oz. 

8  tea- 
spoonfuls 

4 
OZ. 

19 
oz. 

NN 

oz. 

8 

4th  month. 

1  1 

7i  tea- 

4 

17 

4 

7 

oz. 

spoonfuls 

oz. 

oz. 

oz. 

Sth  and  6th  months 

7  tea- 

15 

5 

7 

oz. 

spoonfuls 

oz. 

oz. 

oz. 

7th  month  

15 

6  §  tea- 

4 

13 

5-6 

6 

oz. 

spoonfuls 

oz. 

oz. 

oz. 

Sth  and  9th  months 

17 
oz. 

5*  tea- 
spoonfuls 

4 
oz. 

II 
oz. 

5-6 
oz. 

6 

(a)  Dip  upper  i  ounce  from  each  of  two  quart  bottles  of  milk,  six- 
teen hours  standing.  (&)  Dip  upper  i  ounce  from  each  of  three  quart 
bottles  of  milk,  sixteen  hours  standing,  (c)  (et  seq.)  Dip  quantity  from 
one  quart  bottle  of  milk,  sixteen  hours  standing. 

In  the  above  the  strengthening  is  more  gradual  than  in  the  General 
Formulas. 

Dr.  Henry  Dwight  Chapin  also  recommends  top- 
milk  feeding.  He  uses  the  purest  obtainable  milk, 
taken  from  a  herd  of  cows  and  bottled  and  cooled 
as  quickly  as  possible.  Upon  delivery  such  milk 


236  HYGIENE    OF   THE   NURSERY 

shows  a  distinct  layer  of  cream  in  the  neck  of  the 
bottle.  He  writes: 

"For  young  infants,  remove  from  the  top  of  a 
quart  bottle  all  the  cream  and  enough  milk  to  make 
nine  ounces,  and  mix  in  a  pitcher  or  bowl  for  dilu- 
tion. This  is  called  nine-ounce  top  milk.  (Fat  to 
proteids,  three  to  one). 

"For  the  older  infants,  remove  from  the  top  of  a 
quart  bottle  all  the  cream  and  enough  milk  to  make 
sixteen  ounces  (one  pint)  and  mix  in  a  pitcher  or 
bowl  for  dilution.  This  is  called  sixteen-ounce  top 
milk.  (Fat  to  proteids,  two  to  one). 

"For  young  infants,  one  part  of  the  nine-ounce  top 
milk  should  be  mixed  with  three  to  eight  parts  of  the 
diluent,  and  one  part  of  sugar  added  to  twenty  to  thirty 
parts  of  food;  granulated  or  milk  sugar  may  be  used. 

"For  older  infants,  one  part  of  the  sixteen-ounce 
top  milk  should  be  mixed  with  one  to  two  parts  of 
the  diluent,  and  one  part  of  sugar  added  to  twenty 
to  thirty  parts  of  food;  granulated  or  milk  sugar 
may  be  used. 

"  In  every  instance  begin  on  a  weak  mixture  and 
gradually  decrease  the  dilution." 

The  following  table,  given  by  Dr.  Chapin,  shows 
the  simplicity  of  preparing  food  by  his  method,  and 
indicates  the  quantities  and  dilutions  ordinarily 
required.  Each  mixture  can  be  prepared  from 
one  quart  of  milk: 


DIETARY 


237 


PROGRESSIVE  INCREASE  OF  QUANTITY  AND  STRENGTH  OF 
MIXTURES. 


Sixteen  ounces — one-eighth  top 
milk.  Eight  2-02.  feedings;  one 
every  two  hours. 

Twenty-one  ounces — one-seventh 
top  milk.  Eight  z\  oz.  feedings; 
one  every  two  hours. 

Twenty -four    ounces — one-s  i  x  t  h 

top  milk.  Eight  3-oz.  feedings; 
one  every  two  hours. 

Thirty  ounces — one-fifth  top  milk. 

Seven  4-02.  feedings;  one  every 
two  and  one-half  to  three  hours. 

Thirty-six  ounces — one-fourth  top 
milk.  Six  6-oz.  feedings;  one 
every  three  hours. 

Forty-two  ounces — one-third  top 
milk.  Six  7-oz.  feedings;  one 
every  three  hours. 

Forty  ounces — one-half  top  milk. 

Six  7-oz.  or  five  8-oz.  feedings; 
one  every  three  to  three  and  one- 
half  hours. 

Forty-eight  ounces — two-t  birds 
top  milk.  Six  8-oz.  or  five  10- 
oz.  feedings;  one  every  three  and 
one-half  hours. 


2  oz.  of  9-oz.  top  milk  (after  being 
removed  from  bottle  and  mixed). 

14  oz.  diluted.* 
i  oz.  sugar.t 

3  oz.  of  9-oz.  top  milk  (after  being 
removed  from  bottle  and  mixed) . 

1 8  oz.  diluent. 

1  oz.  sugar. 

4  oz.  of  9-oz.  top  milk  (after  being 
removed  from  bottle  and  mixed) . 

20  oz.  diluent. 

r  oz.  sugar. 

6  oz.  of  p-oz.  top  milk  (after  being 

removed  from  bottle  and  mixed). 
24  oz.  diluent. 
i£  oz.  sugar. 
9    oz.    top   milk   from   one   quart 

bottle. 

27  oz.  diluent. 
ii  oz.  sugar. 

14  oz.   top  milk  from  one  quart 
bottle. 

28  oz.  diluent. 

2  oz.  sugar. 

20   oz.   top   milk  from  one  quart 

bottle. 

20  oz.  diluent, 
i  oz.  sugar. 

i  quart  of  milk, 
i  pint  of  diluent. 


*  Diluent  may  be  water,  plain  cereal  gruel,  or  dextrinized  gruel. 

t  Two  level  tablespoonfuls  of  granulated  sugar  or  three  of  milk 
sugar  equal  about  one  ounce;  either  may  be  used. 

To  make  cereal  gruel,  beat  up  one  or  two  heaped  tablespoon- 
fuls of  barley,  wheat,  or  rice  flour,  or  double  the  quantity  of 
rolled  oats,  with  enough  cold  water  to  make  a  thin  paste.  Pour 
on  a  quart  of  boiling  water,  and  boil  (preferably  in  a  covered  double 
boiler)  for  at  least  fifteen  minutes. 

To  dextrinize,  after  cooking  place  the  boiler  in  cold  water  and 
when  the  gruel  is  cool  enough  to  be  tasted  without  burning  the 
tongue,  add  one  teaspoonful  of  diastase  solution  and  stir.  When 
the  gruel  becomes  thin,  strain,  add  salt,  and  cool. 


238  HYGIENE   OF  THE  NURSERY 

MILK  AND  WHITE-PF-EGG  FOOD. 
The  whites  of  three  eggs. 

Lime-water 3  tablespoonfuls  (fld.  oz.  i£). 

Milk i  pint. 

Shake  the  egg  and  lime-water  forcibly  together 
for  five  minutes;  then  add  the  milk  slowly  with 
constant  stirring,  occupying  ten  minutes  in  the 
process;  keep  in  a  cool  place. 

PEPTONIZED  FOODS. 

For  the  process  of  peptonization,  or  predigestion, 
the  extractum  pancreatis,  prepared  by  Fairchild 
Bros.  &  Foster,  New  York,  gives,  in  my  experience, 
the  most  satisfactory  results,  and  in  all  the  recipes 
given  below  this  preparation  is  to  be  used. 

PEPTONIZED  MILK,  NO.  i. 

One  peptonizing  tube. 

Water i  teacupful  (fld.  oz.  4). 

Milk,  fresh  and  cold i  pint. 

Put  the  powder  contained  in  the  tube  into  a  clean 
quart  bottle;  add  the  cold  water  and  shake  well; 
then  pour  in  the  milk  and  shake  the  mixture  thor- 
oughly again.  Place  the  bottle  in  water  of  about 
115°  F.,  or  so  hot  that  the  whole  hand  can  be  held 
in  it  without  discomfort  for  a  minute,  and  keep  the 
bottle  there  for  ten  minutes.  Then  put  the  bottle 
in  contact  with  ice  to  check  further  digestion  and 
to  keep  the  milk  from  spoiling. 


DIETARY  239 

Peptonized  milk  should  have  a  slightly,  but  not 
decidedly,  bitter  taste.  It  may  be  made  palatable 
by  serving  with  grated  nutmeg,  sugar,  or  a  little 
brandy,  or  it  may  be  taken  with  Apollinaris  or 
Vichy  water.  In  the  latter  case  put  the  water  first 
into  the  glass,  then  quickly  pour  in  the  peptonized 
milk  and  drink  while  effervescing. 

PEPTONIZED  MILK,  NO.  2. 

Mix  the  peptonizing  powder,  water  and  milk  in 
a  bottle,  and  place  in  a  hot-water  bath  exactly  as 
directed  in  the  above.  Let  the  bottle  remain  in  the 
hot  water  for  one  hour,  then  pour  into  a  saucepan 
and  heat  to  boiling.  This  specially  peptonized  milk 
is  used  in  making  jellies,  etc.  It  may  be  immedi- 
ately used  if  required  hot,  or  set  aside  on  ice  for 
punches,  etc. 

The  object  of  raising  the  liquid  to  the  boiling- 
point  is  to  destroy  the  activity  of  the  pancreatin,  so 
that  it  may  not  act  secondarily  upon  other  sub- 
stances prepared  with  the  milk. 

PARTIALLY  PEPTONIZED  MILK. 

Take  the  same  ingredients  mixed  as  before. 
Place  the  saucepan  on  a  hot  range  or  gas  stove 
and  heat  with  constant  stirring  until  the  mixture 
boils,  being  careful  to  so  apply  the  heat  that  boiling 
will  take  place  at  the  end  of  ten  minutes.  When 


240  HYGIENE   OF   THE  NURSERY 

cool  strain  into  a  clean  bottle;  cork  well,  and  keep 
in  a  cool  place.  When  needed  shake  the  bottle 
and  serve  the  required  portion  cool  or  hot  as  desired. 
By  this  method  peptonization  is  more  advanced 
than  by  the  next  process,  but  the  milk  will  not 
become  bitter. 

PEPTONIZATION  BY  COLD  PROCESS. 

Take  the  same  ingredients  and  mix  them  as 
before,  but  immediately  place  the  bottle  on  ice 
without  subjecting  it  to  any  heat. 

This  preparation  is  useful  in  cases  of  enfeebled 
digestive  power,  or  as  a  means  of  returning  from 
predigested  milk  to  ordinary  milk.  It  has  no 
special  taste. 

PEPTONIZED  MILK  GRUEL. 

One  peptonizing  tube. 

Wheat  flour  or  arrowroot i  heaping  teaspoon! ul. 

Water,  cold i  pint. 

Milk,  cold i  pint. 

Make  a  smooth  mixture  of  the  arrowroot  and  water; 
heat  this  with  constant  stirring  until  is  has  boiled 
briskly  for  three  minutes;  next  add  the  milk; 
strain  into  a  pitcher  and  stir  in  the  peptonizing 
powder;  let  the  mixture  stand  in  the  hot-water 
bath,  115°  F.,  for  thirty  minutes;  then  pour  into 
a  clean  bottle  and  place  on  ice. 


DIETARY  241 

PEPTONIZED  BEEF  TEA. 

To  one-quarter  of  a  pound  of  minced  raw  beef, 
entirely  free  from  fat,  add  one-half  pint  of  cold 
water;  cook  over  a  slow  fire,  with  constant  stirring, 
until  it  has  boiled  a  few  minutes;  then  pour  off  the 
liquor  and  beat  or  rub  the  meat  to  a  paste;  put  the 
latter  into  a  jar  with  one- half  pint  of  cold  water, 
and  pour  in  the  liquid  previously  obtained.  Add  to 
this  mixture  twenty  grains  of  extract  of  pancreas 
and  fifteen  grains  of  bicarbonate  of  sodium;  shake 
all  well  together,  and  keep  at  a  temperature  of 
about  110°  to  150°  F.,  stirring  occasionally,  for 
three  hours.  Next  boil  quickly,  strain,  and  serve 
as  required. 

PEPTONIZED  OYSTERS. 

(Originally  suggested  by  the  late  Dr.  N.  A.  Randolph.) 

Take  half  a  dozen  large  oysters  with  their  juice 
and  half  a  pint  of  water.  Heat  in  a  saucepan  until 
they  have  boiled  briskly  for  a  few  minutes.  Pour 
off  the  broth  and  set  aside.  Mince  the  oysters  fine 
in  a  wooden  bowl,  and  reduce  them  to  a  paste  with 
a  potato  masher.  Next  put  the  oysters  in  a  glass 
jar  with  the  broth  which  has  been  set  aside,  and 
add  fifteen  grains  each  of  extract  of  pancreas  and 
bicarbonate  of  sodium.  Let  the  jar  stand  in  hot 
water  or  in  a  warm  place,  where  the  temperature 
is  not  above  115°  F.,  for  one  and  one-half  hours. 

16 


242  HYGIENE   OF   THE   NURSERY 

Next  pour  into  a  saucepan  and  add  half  a  pint  of 
milk;  heat  over  the  fire  slowly  to  boiling  point,  and 
flavor  with  salt  to  taste,  and  serve  hot. 

HUMANIZED  MILK. 

Peptogenic  milk  powder i  level  teaspoonf ul. 

Milk,  fresh  and  cold 4  tablespoonfuls  (fld.  oz.  2). 

Water 4  tablespoonfuls  (fld.  oz.  2). 

Cream i  tablespoonful    (fld.  oz.  J). 

Heat  cautiously  over  a  flame,  stirring  constantly 
with  a  food  thermometer*  and  being  careful  to 
observe  that  the  temperature  is  maintained  at  about 
115°  F.  for  full  six  minutes;  never  let  the  mixture 
boil.  Then  put  into  a  nursing  bottle,  and  cool  to 
98°  F.,  when  it  is  ready  for  administering.  The 
cup  should  be  held  by  the  hand  over  the  flame,  thus 
making  it  easy  to  regulate  the  heat  to  which  the 
milk  is  exposed. 

It  is  important  to  follow  out  these  directions  abso- 
lutely, for  should  the  temperature  of  the  mixture 
not  be  maintained  at  a  sufficiently  high  point,  the 
pancreatin  contained  in  the  peptogenic  powder 
will  perform  its  work  imperfectly;  on  the  other 
hand,  should  the  heat  nearly  approach  the  boiling- 
point  all  digestive  activity  will  be  suspended. 

*  A  bath  thermometer  taken  out  of  its  wooden  frame  makes  a 
serviceable  and  sufficiently  accurate  instrument  for  observing 
temperature  in  food  preparation. 


DIETARY  243 

Humanized  milk  so  prepared  is  adapted  to  the 
average  infant's  digestion.  As  age  advances,  the 
proportion  of  milk  may  be  increased  to  a  proportion 
as  high  as  2  to  i  of  water,  and  the  total  quantity  of 
the  mixture  augmented.  As  an  increase  in  quantity 
is  made,  it  is  necessary  to  preserve  the  relations  of 
the  peptogenic  powder  to  the  liquid;  namely,  one 
teaspoonful  to  each  four  ounces  and  a  half. 

Sometimes  it  will  be  found  necessary  to  carry  the 
process  of  predigestion  further  than  can  be  accom- 
plished by  following  the  directions  already  given. 
This  may  be  readily  done  by  increasing  the  length 
of  the  time  of  heating.  One  can  thus  easily  produce 
in  the  milk  any  degree  of  change  up  to  complete 
peptonization,  when  the  liquid  becomes  clear  and 
very  bitter.  Conversely,  when  it  is  desirable — in 
case  of  returning  health,  for  instance — to  resume 
a  plain  milk  diet,  the  time  of  heating  is  gradually 
shortened  until  the  powder  is  added  to  the  milk 
mixture  just  at  the  time  of  feeding.  When  the  time 
comes  to  abandon  the  digesting  powder  entirely  it 
is  most  important  to  supply  its  place  in  the  food  by 
an  equal  bulk  of  milk  sugar. 

The  milk  and  cream  referred  to  are  of  such  qual- 
ity as  can  be  obtained  from  a  reliable  city  dealer; 
extra  rich  milk  or  cream  may,  under  some  circum- 
stances, require  to  be  more  diluted.  If  it  be  desired 
to  prepare  the  whole  day's  food  supply  at  one  time, 


244  HYGIENE   OF   THE   NURSERY 

the  required  quantity  is  heated  in  bulk  to  115°  F., 
kept  at  this  temperature  for  ten  minutes,  with  con- 
stant stirring,  and  then  brought  quickly  to  the 
boiling  point  (212°)  to  destroy  the  activity  of  the 
pancreatin.  Next  it  is  poured  into  the  feeding 
bottles,  which,  after  being  stopped  with  cotton,  are 
placed  in  cold  water  to  rapidly  cool  the  mixture, 
and  then  in  a  refrigerator  to  await  the  feeding  time 
when  they  are  reheated  to  98°  F. 

MEAT  BROTHS,  ETC. 
BEEF  BROTH. 

Lean  beef  with  bone i  pound. 

Cold  water i  quart. 

Salt i  teaspoonful. 

Boiled  rice  or  barley 2  tablespoonfuls. 

Remove  fat  from  meat  and  cut  into  small  pieces, 
put,  with  crushed  bone,  in  a  kettle,  add  water  and 
let  stand  for  half-an-hour.  Heat  slowly  to  boiling, 
skim  and  add  salt.  Simmer,  without  boiling,  for 
four  hours,  remove  fat  and  strain.  At  time  of 
serving  add  rice  or  barley,  previously  well  soaked 
and  cooked. 

RAW-BEEF  JUICE. 

Take  one  pound  of  sirloin  of  beef;  warm  it  on  a 
broiler  before  a  quick  fire;  cut  into  cubes  of  about 
one-quarter  of  an  inch,  and  after  placing  in  a  lemon 


DIETARY  245 

squeezer  or  meat  press,  forcibly  express  the  juice; 
remove  the  fat  that  rises  to  the  surface  after  cooling. 

This  may  be  given  warm  or  cold,  and  seasoned 
with  a  little  salt,  in  doses  of  one  teaspoonful  every 
two  hours  to  a  child  of  six  months  to  a  year  old. 

The  meat  must  never  be  actually  cooked  and 
must  be  fresh  and  sound. 

RAW  BEEF. 

Cut  a  tenderloin  beefsteak  into  the  finest  possible 
pieces  and  free  it  as  nearly  as  may  be  from  particles 
of  fat;  then  place  in  a  mortar  and  pound  until  the 
meat  becomes  pulpy;  next  rub  through  a  fine  sieve 
and  season  with  salt  and  a  little  black  pepper. 

A  teaspoonful  of  this  pulp  three  or  four  times 
daily  will  be  sufficient  for  a  child  one  year  old. 

CLEAR  BROWN  SOUP. 

Cut  a  shin  of  beef  into  pieces;  put  it  into  a  sauce- 
pan with  just  enough  water  to  cover  it;  when  it 
boils,  skim  it,  and  add  a  bundle  of  sweet  herbs,  a 
little  turnip,  carrot,  onion  and  celery,  and  a  little 
pepper  and  salt.  Let  the  whole  boil  until  the  meat 
is  quite  tender;  then  strain,  and  let  it  stand  until 
the  next  day.  After  clearing  it  thoroughly  from 
fat,  heat  it  again,  adding  as  much  browning  as  will 
make  the  soup  the  color  you  like.  Beat  up  two 
eggs,  with  their  crushed  shells,  till  they  are  quite 


246  HYGIENE   OF   THE   NURSERY 

a  froth.  Put  them  into  the  soup  with  a  whisk;  let 
it  boil  gently  for  ten  minutes;  then  strain  it  through 
a  cloth,  and  it  will  be  perfectly  bright. — (Dr.  Ellis.) 

CONSOMME*. 

Make  a  beef  broth  by  taking  one  or  two  pounds 
of  beef,  according  to  the  strength  required,  from 
the  leg,  round  or  chuck;  wash  well;  cut  in  pieces 
and  put  on  to  boil  in  three  quarts  of  cold  water, 
While  boiling,  skim  frequently,  and  when  reduced  to 
one  quart,  take  from  the  saucepan  and  strain;  after 
which  return  to  the  saucepan  with  a  few  thin  slices 
of  onion,  and  half  a  pound  of  lean  beef,  chopped 
fine,  and  well  mixed  with  three  raw  eggs;  beat  all 
thoroughly  with  the  broth,  which  is  to  be  returned 
to  the  fire  and  boiled  for  about  half  an  hour,  or 
until  perfectly  clear. 

CHICKEN  BROTH. 

A  small  chicken,  or  half  of  a  large  fowl,  thor- 
oughly cleaned,  and  with  all  the  skin  and  fat  re- 
moved, is  to  be  chopped,  bones  and  all,  into  small 
pieces;  put  these,  with  a  proper  quantity  of  salt, 
into  a  saucepan  and  add  a  quart  of  boiling  water; 
cover  closely  and  simmer  over  a  slow  fire  for  two 
hours;  after  removing,  allow  to  stand,  still  covered, 
for  an  hour,  and  strain  through  a  sieve. 


DIETARY  247 

MUTTON  BROTH. 

Lean  loin  of  mutton i  pound  (exclusive  of  bone). 

Water 3  pints. 

Boil  gently  until  very  tender,  about  four  hours,  add- 
ing a  little  salt;  strain  into  a  basin,  and,  when  cold, 
skim  off  the  fat.  Warm  in  a  double  boiler,  when 
served. 

Should  barley  or  rice  be  added,  they  must  be  first 
separately  and  thoroughly  soaked  and  boiled,  and 
added  when  the  broth  is  heated  for  use. 

VEAL  BROTH. 

Lean  veal J  to  i  pound,  according  to 

strength  required. 
Cold  water i  pint. 

Mince  the  meat;  pour  upon  it  a  pint  of  cold  water; 
let  it  stand  for  three  hours;  then  slowly  heat  to 
boiling  point,  and  after  boiling  briskly  for  two 
minutes,  strain  through  a  fine  sieve  and  season 
with  salt. 

OYSTER  SOUP. 

Drain  one  pint  of  oysters  through  a  colander  for 
five  minutes,  to  remove  the  liquor,  and  then  pour 
over  them  one  pint  of  boiling  water,  which  must  be 
thrown  aside;  add  to  the  liquor  already  drained  a 
pint  of  boiling  water  and  put  over  the  fire  in  a  porce- 


248        HYGIENE  OF  THE  NURSERY 

Iain-lined  saucepan.  Boil  until  all  the  scum  has 
risen  and  been  skimmed  off;  then  add  half  a  pint 
of  fresh  milk,  one  water  cracker  rolled  to  a  powder, 
a  piece  of  butter,  and  a  little  salt  and  pepper;  boil 
ten  minutes,  and  just  before  the  soup  is  to  be  served 
turn  in  the  oysters  from  the  colander  and  let  them 
scald  for  three  minutes. 

ARROWROOT  PUDDING. 

Mix  a  tablespoonful  of  arrowroot  with  cold  water; 
put  it  over  the  fire  in  a  porcelain-lined  saucepan; 
add  a  pint  of  boiling  milk,  stirring  constantly,  and 
one  egg  well  beaten  with  a  tablespoonful  of  white 
sugar;  let  it  boil  five  or  ten  minutes. 

If  baked  pudding  be  preferred,  it  may  be  mixed 
in  the  same  way  and  baked,  in  a  moderately  quick 
oven,  for  twenty  or  thirty  minutes. 

BLANC  MANGE. 

Gelatin J  ounce. 

Water i  pint. 

Cream i  pint. 

White  sugar 3  ounces. 

Extract  of  lemon Sufficient  to  flavor. 

Dissolve  the  gelatin  in  the  water  by  means  of  heat, 
meanwhile  whipping  the  cream  and  sugar  together 
and  adding  the  lemon.  Next,  while  the  gelatin 
solution  is  still  warm,  pour  in  the  cream  slowly,  and 


DIETARY  249 

beat  until  stiff  enough  to  drop  from  the  spoon;  finally 
pour  in  moulds. 

Milk  may  be  used  instead  of  water  in  this  prepa- 
ration. 

HOMINY  GRITS. 

Two  tablespoonfuls  of  hominy,  having  been 
thoroughly  soaked  and  boiled  soft,  are  rubbed  up 
with  butter  until  quite  light;  then,  half  a  pint  of 
boiled  milk  is  added  slowly,  with  constant  stirring; 
next  strain  through  a  sieve  and  boil  again;  flavor 
with  sugar  or  salt,  and  serve  hot.  Rice  may  be 
prepared  in  the  same  way. 

JUNKET. 

Milk i  pint. 

Essence  of  pepsin  (Fairchild's) 2  teaspoonfuls. 

(Wine  of  pepsin  or  liquid  rennet  may  also  be  used.) 

Heat  the  milk  to  a  temperature  of  100°  F.  (luke- 
warm), and  add,  with  gentle  stirring,  the  curdling 
agent;  allow  to  stand  until  firmly  curded,  and  serve 
with  sugar,  nutmeg,  or  cream  as  desired. 

JUNKET  WITH  EGG. 

A  good  custard  may  be  made  by  adding  two 
eggs,  beaten  to  a  froth  and  sweetened  with  four 
teaspoonfuls  of  sugar  to  the  pint  of  milk,  and  then 
curdling  with  essence  of  pepsin.  It  is  well  to  pour 


250  HYGIENE   OF   THE   NURSERY 

this,  when  prepared,  into  coffee  cups,  one  of  which 
will  be  enough  to  serve  at  a  time. 

MILK  AND  GELATIN. 

Gelatin i  tablespoonf ul. 

Barley  water,  hot J  pint. 

Powdered  sugar 2  tablespoonf uls. 

Milk i  pint. 

Dissolve  the  gelatin  in  the  hot  barley  water;  add  the 
sugar,  and  then  the  milk,  stirring  all  together. 

RICE  MILK. 

Rice 2  tablespoonf  uls. 

Cornstarch i  teaspoonful. 

Milk 2  pints. 

Boil  in  a  farina  boiler  until  each  grain  of  the  rice 
becomes  saturated,  and  the  whole  creamy  in  color. 

RICE  PUDDING. 

Take  three  ounces  of  rice,  and  swell  it  very  gently 
in  one  pint  of  new  milk.  Let  it  cool;  then  stir  into 
it  one  ounce  of  fresh  butter,  two  ounces  of  pounded 
sugar,  the  yolks  of  three  eggs,  and  some  grated 
lemon  rind.  Pour  this  into  a  well-buttered  dish, 
but  do  not  quite  fill  it,  and  then  lay  lightly  over 
the  top  the  whites  of  three  eggs  which  have  been 
well  beaten  up  with  three  tablespoonfuls  of  sifted 
sugar.  Put  the  pudding  directly  into  the  oven,  the 
heat  of  which  must  be  moderate,  and  bake  it  for 


DIETARY  251 

about  twenty  minutes,  or  till  the  egg  crust  has 
become  lightly  browned. 

OATMEAL  GRUEL. 

Mix  a  large  tablespoonful  of  oatmeal  flour  with 
two  tablespoonfuls  of  cold  water,  stirring  to  bring 
to  a  state  of  uniformity;  pour  this  into  a  pint  of 
boiling  water  in  a  double  boiler,  and  boil  for  twenty 
minutes.  Strain  and  flavor  with  salt  or  sugar. 

SAGO  JELLY. 

Take  two  tablespoonfuls  of  sago;  wash  carefully; 
soak  for  four  hours  in  half  a  pint  of  cold  water,  and 
then  add  half  a  pint  of  hot  water,  a  pinch  of  salt,  a 
tablespoonful  of  sugar  and  a  little  grated  lemon 
peel;  boil  gently  fifteen  minutes,  stirring  constantly. 
A  little  port  wine  or  sherry  may  be  added  just 
before  removing  from  the  fire.  May  be  served  hot 
or  cold. 

TAPIOCA. 

Wash  two  tablespoonfuls  of  the  best  tapioca; 
soak  in  fresh  water  over  night;  add  a  little  salt,  a 
pint  of  milk  or  water,  and  simmer  until  quite  soft, 
stirring  frequently  if  milk  be  used;  then  pour  into 
bowl  and  stir  while  cooling,  at  the  same  time 
adding  sugar,  some  flavoring  substance,  and  wine 
if  desired. 


252  HYGIENE    OF   THE   NURSERY 

TAPIOCA  PUDDING. 

Beat  the  yolks  of  two  eggs  with  half  an  ounce  of 
sugar;  stir  into  a  pint  of  tapioca  mucilage  made  with 
milk,  as  directed  above,  and  bake  in  a  slow  oven. 

EGG  AND  BRANDY. 

Brandy 8  tablespoonfuls  (fld.  oz.  4). 

Cinnamon  water 8  tablespoonfuls  (fld.  oz.  4). 

The  yolks  of  two  eggs. 

White  sugar i  tablespoonful. 

Rub  the  yolks  and  sugar  together;  then  add  the 
cinnamon-water  and  spirit.     A  dessertspoonful  to" 
two  tablespoonfuls  may  be  given  every  two  hours, 
according  to  the  age  of  the  child. 

WINE  WHEY. 

Boil  a  pint  of  fresh  milk;  while  boiling,  pour  in 
eight  tablespoonfuls  of  sherry  wine;  bring  it  to  the 
boil  a  second  time,  being  careful  not  to  stir  it;  when 
it  boils,  put  it  aside  until  the  curd  settles,  and  pour 
off  the  clear  whey. 

FLAX-SEED  TEA. 

Whole  flaxseed i  ounce. 

Bruised  licorice  root 2  teaspoonf uls. 

Water,  boiling i  pint. 

Pour  the  boiling  water  over  the  flax-seed  and  lico- 
rice; cover  lightly;  digest  for  three  hours  near  a 


DIETARY  253 

fire,  and  strain.     Two  tablespoonfuls  of  lemon  juice 
may  be  used  as  the  flavor  instead  of  licorice. 

The  following  preparations  are  useful  as  additions 
to  milk  in  bottle-feeding: 

ALBUMIN-WATER. 

Mix,  by  thoroughly  shaking,  the  raw  whites  of  one 
or  two  fresh  eggs  with  one  pint  of  cold,  pure  water. 
Sugar  or  salt  may  be  added  to  taste. 

BARLEY-WATER. 

Put  two  teaspoonfuls  of  washed  pearl  barley  into 
a  saucepan  with  a  pint  of  clear  water,  and  boil 
slowly  down  to  two- thirds  of  a  pint;  strain  through 
muslin.  Or  blend  carefully  one  or  two  teaspoon- 
fuls, according  to  the  thickness  required,  of  barley 
flour  with  an  equal  quantity  of  cold  water,  add 
gradually  to  one  pint  of  boiling  water  and  boil 
gently  for  twenty  minutes;  strain. 

OATMEAL-  OR  CRACKED-WHEAT  WATER. 

Add  from  i  to  3  tablespoonfuls  of  well-cooked 
oatmeal  or  cracked-wheat  porridge  to  a  pint  of 
water;  heat  almost  to  boiling-point  with  constant 
stirring  until  a  smooth  mixture  is  obtained;  strain. 

RICE-WATER. 

Put  two  tablespoonfuls  of  rice,  thoroughly  washed, 
into  a  quart  of  water  and  place  near  the  fire,  where 
it  may  soak  and  be  kept  warm  for  two  hours;  then 


254  HYGIENE   OF   THE  NURSERY 

boil  slowly  for  one  hour,  or  until  the  water  is  re- 
duced one-half,  and  strain.  Useful  as  a  diluent  for 
milk  in  cases  of  diarrhoea. 

Rice-water  may  be  made  from  the  powdered 
grain  in  the  same  way  as  barley-water. 

LIME-WATER. 

Take  one  heaping  teaspoonful  of  slaked  lime  and 
put  with  one  quart  of  boiled  or  distilled  water  into 
a  bottle,  well  corked,  and  shake  thoroughly  two  or 
three  times  at  intervals  of  half  an  hour;  then  allow 
to  settle  and  after  twenty-four  hours  siphon  off,  for 
use,  the  upper  clear  fluid;  this  should  be  put  in  a 
perfectly  clean  bottle  which  must  be  kept  securely 
stopped. 

WHEY. 

Milk i  pint. 

Essence  of  pepsin  (Fairchild's) 2  teaspoonfuls. 

Heat  the  milk  to  a  temperature  of  100°  F.,  and  add 
the  pepsin  with  gentle  stirring;  let  the  whole  stand 
until  firm  coagulation  has  taken  place;  then  beat 
with  a  fork  until  the  curd  is  finely  divided,  and 
strain. 

If  the  whey  is  to  be  used  with  cream  in  feeding, 
it  should,  after  being  strained,  be  reheated  to  a 
temperature  of  160°  F.  and  so  kept  with  constant 
stirring  for  three  minutes.  The  object  of  this  is 


DIETARY  255 

to  check  the  curdling  activity  of  the  excess  of  pepsin, 
so  that  when  the  cream  is  added  there  may  be  no 
precipitation  of  its  casein  and  the  formation  of  a 
curdy  mixture. 

GELATIN. 

Put  a  piece  of  plate  gelatin,  an  inch  square,  into 
half  a  tumblerful  of  cold  water,  and  let  it  stand  for 
three  hours;  then  turn  the  whole  into  a  teacup, 
place  this  in  a  saucepan  half  full  of  water,  and  boil 
until  the  gelatin  is  dissolved.  When  cold,  this 
forms  into  jelly.  From  one  to  two  teaspoonfuls 
may  be  added  to  each  bottle  of  milk  food.  Em- 
ployed as  an  attenuant. 

FLOUR-BALL. 

Take  a  pound  of  good  wheat  flour — unbolted,  if 
possible;  tie  it  up  very  tightly  in  a  strong  pudding- 
bag;  place  it  in  a  saucepan  of  water  and  boil  con- 
stantly for  ten  hours;  when  cold  remove  the  cloth; 
cut  away  the  soft  outer  covering  of  dough  that  has 
been  formed,  and  reduce  the  hard,  baked  interior 
by  grating. 

In  the  yellowish-white  powder  obtained,  almost 
all  the  starch  has  been  converted  into  dextrin  by 
the  process  of  cooking,  and  the  proportion  of  the 
nitrogenous  principle  to  the  calorifacient  is  as  one 
to  five — nearly  the  same  as  in  human  milk. 

This  acts  both  mechanically  and  as  a  food. 


256  HYGIENE   OF   THE   NURSERY 

PEARL-BARLEY  JELLY. 

Put  three  tablespobnfuls  of  pearl  barley  soaked 
over  night  into  a  double  boiler  with  a  quart  of 
clear  water  and  boil  slowly  down  to  a  pint;  strain, 
and  allow  the  liquid  to  set  into  a  jelly.  In  making 
this  jelly  from  barley  flour,  thoroughly  mix  one 
tablespoonful  of  this  flour  with  two  tablespoonfuls 
of  cold  water,  add  gradually  to  four  ounces  of  boil- 
ing water  and  boil  for  twenty 
minutes;  strain. 

Used    for    same    purpose    as 
barley  water. 

NUTRITIOUS  ENEMATA. 

The  process  of  peptonization, 
already  described,  is  very  useful 
in  the  preparation  of  food  for 
absorption  by  the  lining  mem- 
brane of  the  rectum.  Peptonized 
milk  No.  i,  or  an  egg  mixed  with 
a  pint  of  milk  and  thoroughly 
peptonized,  is  the  best  food  for 
FIG.  ^.-SYRINGE  FOR  employment  in  this  way,  the 

NUTRITIOUS  ENEMATA.  r     J  J  \ 

only  caution  being  to  administer 
in  small  quantities — from  four  to  eight  tablespoon- 
fuls according  to  age — and  at  intervals  of  not 
less  than  four  hours.  The  injection  should  be 
made  gently  and  slowly  and  the  liquid  should  be 


DIETARY  257 

warmed  to  a  temperature  of  98°  F.  It  is  essen- 
tial, too,  in  rectal  feeding  to  keep  the  lower  bowel 
clear  by  a  daily  irrigation  of  warm  (98°  F.)  normal 
saline  solution  (i  teaspoonful  of  salt  to  i  pint  of 
boiled  water). 

The  best  syringe  for  the  operation  is  shown  in 
Fig.  23. 

DIET  IN  SPECIAL  DISEASES. 

In  formulating  the  following  diet  lists  it  is  neces- 
sary to  adapt  them  to  definite  ages,  but,  provided 
the  essential  idea  is  adhered  to,  the  quantity  of  the 
food  may  be  increased  or  diminished  and  the 
quality  altered  to  suit  the  age  of  the  special  patient. 

PARTIAL  PEPTONIZATION  FOR  FEEBLE  DIGESTION 
—AGE,  FOUR  MONTHS. 

Make  each  bottle  of  food  as  follows: 

Cream i  tablespoonful    (fld.  oz.    £). 

Milk 5  tablespoonfuls  (fld.  oz.  zj). 

Water 4  tablespoonfuls  (fld.  oz.  2  ). 

Peptogenic  milk  powder...  .    i  level  teaspoonful. 

After  mixing,  heat  cautiously  over  a  flame  for  six  minutes, 
stirring  constantly  with  a  food  thermometer,  being  very  careful 
that  the  temperature  of  the  mixture  is  maintained  between  115° 
and  120°  F.  Do  not  boil.  Cool  to  98°  F.  before  administering. 

Feed  every  two  and  one-half  hours  from  6  A.M.  to  10  P.M. 

In  case  each  bottle  cannot  be  prepared  separately — by  far  the 
better  way — the  whole  quantity  for  each  day  may  be  prepared  in 
the  morning  as  follows: 

17 


258  HYGIENE   OF   THE   NURSERY 

Cream 8  tablespoonfuls  (fld.  oz.    4). 

Milk 40  tablespoonfuls  (fld.  oz.  20). 

Water 32  tablespoonfuls  (fld.  oz.  16). 

Peptogenic  milk  powder 8  level  teaspoonfuls. 

Heat  slowly,  so  as  to  bring  to  a  full  boil  at  the  end  of  ten 
minutes;  fill  eight  graduated  nursing  bottles  to  the  5~oz.  mark, 
cork  with  cotton,  and  place  in  nursery  refrigerator;  heat  to  98° 
F.  at  time  of  administration. 

To  return  to  unpeptonized  diet,  gradually  reduce  the  time  of 
heating,  and  finally  replace  the  milk  powder  by  sugar  of  milk  and 
salt. 

A  mixture  stronger  than  2  parts  of  milk  to  i  part  of  water  is 
difficult  to  predigest  without  curdling,  especially  if  the  milk  be  of 
more  than  ordinarily  good  quality. 

"NO-MILK"  DIET  FOR  ACUTE  GASTRO-INTESTINAL 
DISORDERS— ACUTE     VOMITING,      ENTERO-CO- 
LITIS,    CHOLERIFORM    DIARRHCEA,    ETC.— AGE, 
SIX  MONTHS, 
i. 

Whey 4  tablespoonfuls  (fld.  oz.  2). 

Barley-water 4  tablespoonfuls  (fld.  oz.  2). 

Milk  sugar i  teaspoonful. 

For  one  portion,  to  be  given  every  two  hours. 
2. 

Flour-ball  or  barley-jelly .    i  teaspoonful. 

Water 8  tablespoonfuls  (fld.  oz.  4). 

Mix  and  add  half  the  white  of  a  fresh  egg. 

For  one  portion,  to  be  given  every  two  hours. 

3- 

Veal-broth  (£  Ib.  of  meat  to  a  pint  of  water), 

Barley-water of  each,  4  tablespoonfuls  (fld.  oz.  2). 

For  one  portion,  to  be  given  every  two  hours. 

4- 

Raw-beef  juice 1-2  teaspoonfuls  (fld.  dr.  1-2). 

Every  two  hours. 


DIETARY  259 

While  on  No.  4  the  patient  must  take  from  12  to  24  fluidounces 
of  pure  water,  barley-water,  or  white-of-egg  water  each  twenty- 
four  hours:  to  be  given  in  small  doses  at  short  intervals. 

Resume  milk  feeding  gradually  after  using  any  of  these  diets. 
Partially  peptonized  milk  food  is  the  best  intermediate  diet. 

DIET  FOR  CHRONIC   GASTRO-INTESTINAL 

CATARRH— MUCOUS   DISEASE    OF 

OLDER  CHILDREN. 

Breakfast,  7.30  A.M. — One  or  two  tumblerfuls  (fld.  oz.  8)  of  milk 
guarded  by  lime-water  (fld.  oz.  2  to  tumblerful),  the  yolk  of  a 
soft-boiled  egg,  and  a  thin  slice  of  stale  unbuttered  bread. 

Luncheon,  n  A.M. — A  cup  (fld.  oz.  4)  of  beef-,  chicken-,  or  mutton- 
broth,  entirely  free  from  fat,  and  a  thin  slice  of  dry  toast. 

Dinner,  2.30  P.M. — Broiled  mutton-chops  entirely  free  from  fat 
(one  or  two,  according  to  size),  a  large  spoonful  of  well-boiled 
spinach,  and  a  slice  of  stale  dry  bread. 

Supper,  7  P.M. — One  or  two  tumblerfuls  of  milk  guarded  by  lime-' 
water,  and  a  slice  of  dry  toast. 
For  drink,  pure  water  or  Vichy. 

Articles  permissible  for  variety. — Beef,  poultry,  game,  fresh  fish, 
raw  oysters,  cauliflower-tops,  asparagus,  lettuce,  celery,  turnips, 
onions,  carrots. 

Articles  to  be  avoided. — All  farinaceous  substances,  except  stale 
or  toasted  bread  (wheat  or  bran) ;  even  this  must  be  restricted 
in  quantity;  potatoes,  peas,  beans,  parsnips,  fruit-cake,  pastry, 
sweetmeats,  and  butter;  tea,  coffee,  beer,  wine,  and  all  condi- 
ments except  salt. 
If  there  be  great  debility,  small  doses  of  whiskey  well  diluted 

may  be  allowed.     Keep  skin  active  by  bathing,  frictions,  inunc- 
tions with  good  olive  oil,  and  warm  clothing. 

DIET  FOR  CHRONIC  VOMITING  IN  INFANTS. 

Fresh  cream i  tablespoonful    (fld.  oz.  |). 

Whey 2  tablespoonfuls  (fld.  oz.  i). 

Barley-water 2  tablespoonfuls  (fld.  oz.  i). 


260  HYGIENE   OF   THE   NURSERY 

Or, 

Weak  veal-broth  (|  Ib.  of  veal  to  a  pint  of  water). 
Thin  barley-water equal  quantities. 

Either  food  is  best  given  cold,  in  small  quantities  and  at  short 
intervals — i.e.,  one  teaspoonful  every  fifteen  minutes  in  bad  cases. 
As  improvement  begins,  increase  both  quantity  and  intervals,  but 
continue  to  feed  with  a  spoon.  After  the  stomach  has  been  re- 
tentive for  forty-eight  hours,  gradually  return  to  bottle-feeding. 

Mjlk  food  must  be  very  dilute,  and  partially  predigested  at 
first. 

In  extreme  cases  No.  4  No-milk  Diet  (p.  258)  may  be  required 
for  a  time. 

DIET  FOR  CHRONIC  DIARRHCEA  WHEN  MILK  FOODS 
UNDERGO   ACID   FERMENTATION— AGE 

SDC  TO  TWELVE  MONTHS. 
First  meal,  7  A.M. 

Veal-broth  (^  Ib.  of  veal  to  a  pint  of  water), 
Barley-water ...  of  each,  6-8  tablespoonfuls  (fld.  oz.  3-4). 
Second  meal,  10  A.M. 

Cream i  tablespoonful  (fld.  oz.  £). 

Whey  (freshly  prepared) ....   12  tablespoonfuls  (fld.  oz.  6). 
Third  meal,  i  P.M. 

•  Same  as  first,  with  chicken-broth  in  place  of  veal-broth. 
Fourth  meal,  5  P.M. 
Same  as  second. 
Fifth  meal,  10  P.M. 
Same  as  first. 

If  feeble,  one  meal  at  4A.M.,  same  as  second. 
In   extreme   cases   No.  4  No-milk   Diet    (page  258)  may  be 
required  temporarily,  with  twice  each  day — 
The  yolk  of  a  raw  egg, 
Ten  (10)  drops  of  brandy, 
One  (i)  teaspoonful  cinnamon- water,  and 
One  (i)  coffeespoonful  white  sugar, 
Well  beaten  up. 


DIETARY  26l 

Partial  peptonization  is  an  important  intermediary  in  resuming 
ordinary  milk  feeding. 

Older  children  require  the  diet  for  chronic  gastro-intestinal 
catarrh. 

DIET  FOR  HABITUAL  CONSTIPATION  IN  INFANTS- 
AGE,  THREE  MONTHS, 
i. 

Cream i  tablespoonful     (fld.  oz.  ^). 

Milk 4  tablespoonfuls   (fld.  oz.  2). 

Milk  sugar i  teaspoonf ul        (dram     i) . 

Salt a  pinch. 

Bethlehem    oatmeal    (fine 

powder) 2  teaspoonf uls     (drams   2  ) . 

Water 3  tablespoonfuls  (fld.  oz.  i$). 

Heat  water  almost  to  boiling-point;  add  the  oatmeal  slowly  with 
stirring  until  a  smooth  mixture  is  obtained  and  boil  in  a  double 
boiler  for  twenty  minutes;  then  add  the  other  ingredients. 

One  or  two  such  feedings  each  day  will  usually  be  sufficient, 
but  the  oatmeal  may  be  added  to  each  bottle  if  necessary. 
2. 

Cream i  tablespoonful   (fld.  oz.   £). 

Milk 4  tablespoonfuls  (fld.  oz.  2  ). 

Milk  sugar i  teaspoonf  ul       (dram     i  ) . 

Phosphate  of  sodium 2  grains. 

Wheat- water 3  tablespoonfuls  (fld.  oz.  i£). 

To  make  wheat-water,  add  to  i  pint  of  water  i  or  2  tablespoon- 
fuls (according  to  effect  desired)  of  thoroughly  cooked  cracked- 
wheat  porridge;  heat  a  little  short  of  the  boiling-point,  stir  con- 
stantly until  a  mixture  is  obtained,  and  strain. 

Dissolve  phosphate  of  sodium  in  a  teaspoonf  ul  of  hot  water, 
and  add  to  food  just  before  administration.  May  be  used  in  one 
or  more  feedings  as  required. 

One  or  two  teaspoonf  uls  of  fresh,  sweet  orange  juice  midway 
between  the  second  and  third  feeding. 
Encourage  infant  to  take  water. 


262  HYGIENE   OF   THE   NURSERY 

Massage  of  abdomen  with  warm  olive  oil,  over  and  in  the  course 
of  the  colon,  twice  daily,  is  of  much  service. 

DIET    FOR    HABITUAL    CONSTIPATION    IN    OLDER 
CHILDREN— AGE,  EIGHTEEN  MONTHS  TO 
TWO  AND  ONE-HALF  YEARS. 

First  meal,  7  A.M. — A  breakfast-cupful  (fld.  oz.  8)  of  new  milk, 
with  an  additional  tablespoonful  (fld.  oz.  £)  of  cream;  2  to  4 
tablespoonfuls  of  thoroughly  cooked  oatmeal  or  cracked-wheat 
porridge,  with  cream  and  salt;  two  slices  of  whole  wheat  or  bran 
bread  buttered.  One  hour  before  breakfast  the  juice  of  a  ripe 
orange,  or  half  of  a  moderate  sized  ripe  apple  scraped  with  a 
spoon,  or  a  small  ripe  pear,  scraped,  or  a  peach. 

Second  meal,  n  A.M. — A  teacupful  (fld.  oz.  6)  of  milk,  with  an 
additional  tablespoonful  (fld.  oz.  £)  of  cream;  a  slice  of  bran 
bread. 

Third  meal,  2  P.M. — A  breakfast-cupful  (fld.  oz.  8)  of  mutton-  or 
chicken-broth,  or  i  or  2  tablespoonfuls  of  underdone  roast 
mutton,  or  beef,  or  chicken  minced  fine  and  pounded  to  a  paste; 
puree  of  spinach;  mashed  cauliflower- tops;  asparagus-tops; 
stewed  celery;  whole  wheat  or  bran  bread,  buttered;  junket 
and  cream;  rice-and-milk  pudding  with  stewed  prune  juice; 
baked  apple  with  cream. 

Fourth   meal,   6.30   P.M. — Milk,    one   or   two   breakf ast-cupf uls ; 
whole  wheat  or  bran  bread,  buttered;  stewed  fruit. 
For  drink,  pure  water  only.     No  condiment  but  salt. 
Avoid  farinaceous  foods,  sugar,  candy,  cake  and  pastry. 
Massage  of  abdomen  with  warm  olive  oil,  over  and  in  the 

course  of  the  colon,  twice  daily,  is  of  much  service. 

DIET  IN  INFANTILE  SCURVY— AGE,  EIGHT  MONTHS. 

First  meal,  7  A.M. 

Cream i  tablespoonful  (fld.  oz.    £). 

Milk 9  tablespoonfuls  (fld.  oz.  4^). 

Milk  sugar i  teaspoonful  (dram     i  ). 

Salt a  pinch. 

Water 6  tablespoonfuls  (fld.  oz.  3  ). 


DIETARY  263 

At  9  A.M.,  one  to  two  teaspoonfuls  of  fresh  orange  juice, 

according  to  effect  on  bowels. 
Second  meal,  10.30  A.M.,  same  as  first. 

At  11.30  A.M. — Two  teaspoonfuls  of  fresh  raw-beef  juice,  free 

from  fat,  and  with  a  little  salt. 

At  i  P.M. — One  to  two  teaspoonfuls  of  fresh  orange  juice. 
Third  meal,  2  P.M.,  same  as  first. 

At  3  P.M. — Two  teaspoonfuls  of  fresh  raw-beef  juice  with  salt. 
At  5  P.M. — One  to  two  teaspoonfuls  of  fresh  orange  juice. 
Fourth  meal,  6  P.M.,  same  as  first. 

At  8  P.M. — Two  teaspoonfuls  of  fresh  raw-beef  juice  with  salt. 
Fifth  meal,  10  P.M.,  same  as  first. 

Milk  may  be  pasteurized  or  predigested  if  absolutely  necessary, 
but  never  sterilized,  for  use  in  scurvy.     Avoid  all  infant  foods. 


DIET  IN  ACUTE  NEPHRITIS,  SCARLATINAL  OR 
CATARRHAL— AGE,  FOUR  YEARS. 

First  meal,  7. 30  A.M. 

Milk 4  tablespoonfuls    (fld.  oz.  2  ). 

A  good  malt  food i  tablespoonful    (oz.  ^). 

Barley-water n  tablespoonfuls  (fld.  oz.  5^). 

Second  meal,  10.30  A.M. — A  teacupful  (fld.  oz.  6)  of  whey. 
Third  meal,    1.30  P.M. — A  teacupful   (fld.  oz.   6)   of  veal-broth 
(^  Ib.  of  veal  to  a  pint  of  water),  mutton-broth   (^  Ib.  of 
mutton  to  a  pint  of  water),  or  chicken-broth;  4  to  8  table- 
spoonfuls  of  a  light  farinaceous  pudding. 
Fourth  meal,  4.30  P.M. — Same  as  second. 
Fifth  meal,  7  P.M. — Same  as  first. 
Sixth  meal,  10  P.M. — Same  as  second. 

One  or  two  whey  feedings  may  be  given  during  the  night  if 
required. 

Allow  plenty  of  pure  water — Poland  water. 
In  order  to  spare  the  kidneys,  avoid  food  having  much  nitrogen- 
ous waste — i.  e.,  eggs,  meat,  or  too  much  milk. 


264  HYGIENE    OF   THE   NURSERY 

DIET  IN  LITH^EMIA,  EXCESS  OF  URIC  ACID  IN  URINE, 
GOUTY  ECZEMA,  ETC.— AGE,  FOUR  YEARS. 

First  meal,  8  A.M. — Milk,  7  fluidounces,  Vichy  water,  i  fluid- 
ounce  (one  or  two  portions);  one  or  two  yolks  of  soft-boiled 
eggs  with  salt,  or  a  bit  of  fresh  fish  or  sweetbread;  or  one  or 
two  slices  of  bran  or  whole  wheat  bread,  dry. 

Second  meal,  1.30  P.M. — A  teacupful  of  clear  meat-broth;  a  piece 
of  chicken,  turkey,  wild  fowl,  or  fish;  one  well-cooked  green 
vegetable — i.  e.,  spinach,  celery,  young  onions,  cauliflower; 
one  or  two  slices  of  dry  bran  or  whole  wheat  bread;  junket  or 
rice-and-milk  pudding. 

Third  meal,  6.30  P.M. — Milk  as  at  first  meal;  sweetbread  or  milk- 
toast;  dry  bran  or  whole  wheat  bread. 

For  drink,  Poland  water  or  Vichy  (domestic) ;  use  either  freely. 
Avoid  fats,  starches,  sweets,   and   red   meats — i.  e.,  beef  or 

mutton. 

Exercise  in  fresh  air  is  important. 


DIET  IN  RICKETS  WITHOUT  DIARRHCEA— AGE, 
EIGHTEEN  MONTHS. 

(If  diarrhoea  be  a  symptom,  use  diet  for  chronic  diarrhoea.) 
First  meal,   7.30  A.M. — A  breakfast-cupful  (fld.  oz.  8)  of  milk, 
with  a  tablespoonful  (fld.  oz.  £)  of  cream;  on  alternate  days 
the  yolk  of  a  soft-boiled  egg,  with  a  little  butter,  salt,  and  bread 
crumbs,  and  two  tablespoonfuls  of  well-cooked  and  strained 
cracked-wheat  porridge  with  cream  and  salt. 
Second  meal,   n  A.M. — A  breakfast-cupful  (fld.  oz.  8)  of  milk, 
with  a  tablespoonful  (fld.  oz.  £)  of  cream  and  a  slice  of  whole 
wheat  bread. 

Third  meal,  2  P.M. — A  good  tablespoonful  of  well-minced  and 
pounded  mutton  or  chicken,  with  gravy  and  a  little  crumbled 
stale  bread;  a  tablespoonful  of  puree  of  spinach,  or  stewed 
celery  or  asparagus  tops,  or  cauliflower  tops;  thin  bread  and 
butter. 


DIETARY  265 

Fourth  meal,  6  P.M. — Milk  and  cream  as  at  first  and  second  meals; 
thin  bread  and  butter. 
Drink  pure  water  and  avoid  excess  of  farinaceous  food. 

DIET  IN  PULMONARY  PHTHISIS— AGE,  SEVEN  YEARS. 

First  meal,  8  A.M. — A  breakfast-cupful  (fld.  oz.  8)  of  milk,  alkalin- 
ized  with  gr.  v  sodii  bicarb.;  a  soft-boiled  egg,  or  broiled  fresh 
fish,  or  stewed  sweetbread;  thin  bread,  buttered. 

Second  meal,  u  A.M. — Raw  or  stewed  oysters,  or  a  teacupful  of 
meat-,  oyster-,  or  clam- broth;  thin  bread,  buttered. 

Third  meal,  2.30  P.M. — A  slice  of  roast  beef,  or  mutton,  with 
gravy,  or  of  poultry  or  game;  a  mealy  potato,  mashed,  or  well- 
cooked  rice;  light  farinaceous  pudding  made  with  milk;  bread 
and  butter;  one  to  two  tablespoonfuls  (fld.  oz.  J-i)  of  a  good 
dry  sherry  well  diluted  with  water. 

Fourth  meal,  6.30  P.M. — A  breakfast-cupful  (fld.  oz.  8)  of  chocolate 
or  cocoa;  milk-toast;  stewed  oysters  or  sweetbread;  bread  and 
butter. 
Farinaceous  food  and  all  fat-forming  material  are  indicated,  but 

caution  in   administration  is  necessary  on  account  of  associated 

tendency  to  dyspepsia  with  acid  fermentation. 

DIET  AND  REGIMEN  IN  CHOREA— CHILDHOOD. 

Confine  patient  to  bed,  and  keep  in  recumbent  position. 

At  5.30  A.M.,  a  breakfast-cupful  (fld.  oz.  8)  of  warm  milk. 

At  7  A.M.,  a  breakfast-cupful  (fld.  oz.  8)  of  warm  milk;  three 

slices  (i  oz.  each)  of  bread,  buttered. 
At  9  A.M.,  2  to  4  tablespoonfuls  (fld.  oz.  1-2)  of  a  good  liquid 

extract  of  malt;  or   i   tablespoonful  of  Merck's  dry  malt 

made  into  a  sandwich  with  bread  and  butter. 
At  10  A.M.,   massage  for  fifteen  minutes;  afterwards  give  a 

teacupful  (fld.  oz.  6)  of  warm  milk. 
At  12.30  P.M.,  dinner  of  well-cooked  fresh  vegetables;  bread; 

a  breakfast-cupful  (fld.  oz.  8)  of  milk;  rice  or  other  light 

pudding. 


266  HYGIENE    OF   THE   NURSERY 

At  4.15  P.M.,  same  as  7  A.M.,  with  a  soft-boiled  egg. 

At  7  P.M.,  extract  of  malt  as  at  9  A.M. 

At  7.30  P.M.,  massage;  afterwards  give  a  teacupful  (fld.  oz  6) 
of  warm  milk. 

At  the  end  of  two  weeks  increase  the  amount  of  bread  to  four 
slices,  add  a  lamb  chop  or  a  piece  of  chicken  to  the  dinner  (12.30 
P.M.),  and  increase  portions  of  milk  so  that  an  extra  pint  is  taken 
during  the  day.  Allow  the  patient  to  sit  up  in  bed  and  have  toys 
to  play  with.  Massage  to  be  increased  to  half  an  hour  each  time. 

Never  hurry  the  patient  out  of  bed,  especially  in  severe  cases. 


CHAPTER  X. 

MASSAGE. 

Systematic  manipulation  is  of  great  value  both  as 
a  means  of  preserving  health  and  as  a  scientific 
method  of  treating  certain  diseases  in  children. 

Mere  rubbing  or  friction  of  the  surface  cannot  be 
included  under  massage  in  its  literal  sense;  still,  it 
is  a  useful  form  of  manipulation,  and  needs  no 
special  instruction,  being  possible  to  any  intelli- 
gent, soft-handed  mother  or  nurse. 

Massage,  on  the  contrary,  is  an  art,  and,  like 
every  other  art,  requires  study  and  patient  prepara- 
tion for  its  successful  practice.  It  is  a  powerful 
remedy,  too,  and,  like  other  agents  of  its  class,  as 
potent  for  evil  as  for  good  in  unskilled  hands. 
Therefore,  to  insure  good  results,  a  trained  masseuse 
is  necessary,  and  she  must  act  under  the  direction 
of  the  physician. 

Massage  includes  several  processes  of  manipula- 
tion. Those  given  by  Murrell,  from  whose  excel- 
lent little  work*  I  have  taken  much  of  the  descrip- 
tion of  the  different  "  movements,"  are  effleurage, 
petrissage,  friction,  and  tapotement. 

*  "Massage  as  a  Mode  of  Treatment."     W.  Murrell. 
267 


268  HYGIENE    OF   THE   NURSERY 

Effleurage  is  a  stroking  movement  made  with  the 
palm  of  the  hand  passing  with  more  or  less  force 
over  the  surface  of  the  body  centripetally.  The 
movements  are  made  to  follow  as  nearly  as  possible 
the  direction  of  the  muscle  fibers,  and  for  deep- 
seated  tissues  the  knuckles  can  be  used  instead  of 
the  palm.  This  method  is  of  minor  value  in  itself, 
but  of  great  use  when  combined,  as  is  the  rule,  with 
the  procedures  to  be  described. 

Petrissage  consists  essentially  in  picking  up  a 
portion  of  muscle  or  other  tissue  with  both  hands 
or  the  fingers  of  one  hand,  and  subjecting  it  to  firm 
pressure,  at  the  same  time  rolling  it  between  the 
fingers  and  the  subjacent  tissues.  The  hands  must 
move  simultaneously  and  in  opposite  directions,  the 
skin  must  move  with  the  hands  to  avoid  giving 
pain,  and  the  thumb  and  fingers  must  be  kept 
wide  apart  in  order  to  grasp  a  bulk  of  tissue,  a 
whole  muscle  belly,  for  instance.  The  manipulation 
must  be  uniform,  in  a  direction  from  the  extremities 
toward  the  centre  of  the  body,  bearing  in  mind  the 
arrangement  of  groups  of  superficial  muscles  and 
keeping  well  in  the  spaces  between  them. 

Friction,  or  massage  a  frictions,  is  performed 
with  the  tips  of  the  fingers.  It  is  a  pressure  move- 
ment rather  than  a  rubbing.  It  is  always  associated 
with  effleurage,  and,  to  be  of  any  use,  must  be  per- 
formed quickly  and  readily. 


269 

Tapotement  is  a  percussion  which  may  be  made 
with  the  tips  of  the  fingers,  their  palmar  surfaces, 
the  palm  of  the  hand,  the  back  of  the  half-closed 
hand,  one  or  other  border  of  the  hand,  or  with 
the  hand  partly  closed,  so  as  to  contain,  when 
brought  in  contact  with  the  surface  of  the  body, 
a  cushion  of  air. 

The  hand  of  the  masseuse  must  be  perfectly  clean 
and  soft,  and  the  finger-nails  short  and  smooth. 
The  length  and  frequency  of  the  sittings  must  vary 
with  the  individual  case.  Most  authorities  are  in 
favor  of  short  and  frequent  seances,  and  except  in 
special  cases  recommend  dry  massage,  that  is, 
without  the  use  of  oil,  liniments  or  ointments; 
vaseline  especially  is  to  be  avoided. 

Clinical  experience  shows  that  massage  increases 
the  activity  of  the  circulation,  reddens  the  skin,  and 
elevates  the  temperature  in  the  part  manipulated. 
It  also  increases  the  electrical  contractility  of  mus- 
cular tissue,  and  stimulates  the  flow  of  lymph 
in  the  lymphatic  vessels.  Muscular  stiffness  and 
fatigue  are  relieved,  nervous  irritability  is  calmed, 
and  restless  and  wakeful  patients  are  soothed  by  it 
into  refreshing  sleep. 

With  these  facts  at  hand,  it  is  not  difficult  to  see 
what  a  useful  agency  we  possess  in  skilfully  em- 
ployed massage.  By  its  application  we  have  the 
power  to  prevent  the  wasting  of  muscles  and  to 


270  HYGIENE   OF   THE    NURSERY 

augment  muscle  strength,  to  build  up  such  tissues 
as  fat  and  blood,  to  improve  nerve  force,  both 
directly  by  producing  a  better  blood  supply  and 
indirectly  by  relieving  irritability  and  giving  rest 
and  sleep;  and  finally,  to  hasten  the  absorption  of 
waste  tissue  and  of  morbid  effusions.  At  the  same 
time  it  must  always  be  remembered  that  massage 
is  a  powerful  remedy.  A  short  seance  with  gentle 
movements  may  do  good  in  infantile  palsy,  for  ex- 
ample, but  it  does  not  follow  that  by  doubling  the 
time  or  force,  twice  as  much  benefit  will  be  derived. 
In  fact,  the  reverse  of  the  proposition  is  true;  short, 
gentle  massage  maintains  the  size  and  strength  of 
the  muscles,  while  long,  forcible  manipulation 
causes  them  to  waste  quickly.  The  same  truth 
runs  through  the  whole  question  and  must  be 
observed. 

Before  entering  upon  the  therapeutic  application 
of  massage  proper,  it  will  be  well  to  revert  to  the 
process  of  simple  rubbing,  already  mentioned. 
This  is  of  much  value  as  a  general  hygienic  measure. 
Each  day,  after  the  bath,  the  skin  having  been  thor- 
oughly dried  by  a  soft,  warm  towel,  the  whole  surface 
should  be  gently  rubbed  with  the  palm  of  the  hand, 
the  process  occupying  about  five  minutes.  This 
increases  the  circulation  in  the  minute  blood-vessels, 
encouraging  thorough  reaction,  aids  nutrition  and 
adds  vigor  to  the  frame.  Weakly  children  especi- 


MASSAGE  271 

ally  thrive  under  it.  In  older  children,  friction  with 
a  soft  towel  may  be  substituted  for  hand-rubbing, 
but  this  change  should  not  be  made  before  the  fifth 
or  sixth  year. 

Sometimes  it  is  well  to  rub  certain  portions  of  the 
body  more  thoroughly  than  others.  Thus  in  rickets 
the  spine  should  receive  special  attention,  in  indi- 
gestion and  constipation,  the  abdomen;  in  weak 
ankles,  the  feet  and  legs,  etc.;  although  even  in 
these  cases  the  general  surface  must  receive  a  share. 

Massage  may  be  employed  with  advantage  in  the 
following  diseases  of  childhood: 

(a)  Long-standing  stomach  or  intestinal  indiges- 
tion (chronic  gastro-intestinal  catarrh).  In  this 
condition  the  skin  is  harsh,  and  often  so  dry  that 
a  shower  of  dead  scales,  falls  from  the  surface  on 
the  removal  of  the  underclothing;  the  muscle  tone 
is  faulty;  general  nutrition  is  impaired,  and  there  is 
a  determination  of  blood  from  the  surface  toward 
the  mucous  membranes.  To  get  the  skin  active, 
and  in  this  way  balance  the  circulation,  is  an  im- 
portant step  in  the  reestablishment  of  normal  diges- 
tion, secretion  and  excretion,  the  essentials  of  per- 
fect nutrition.  To  accomplish  this,  a  full,  warm 
bath  is  administered  every  evening,  just  before 
bedtime,  the  patient  remaining  in  the  water  for  five 
minutes.  Then  the  surface  is  thoroughly  dried,  and 
half  an  ounce  of  olive  oil  is  gently  rubbed  into  the 


272  HYGIENE    OF   THE   NURSERY 

skin  (inunction),  the  child  enveloped  in  a  light 
blanket  and  put  to  bed.  After  a  little  time  sweat- 
ing begins.  As  soon  as  the  sweating  is  free  the 
skin  is  again  dried  and  the  night-dress  put  on  in 
preparation  for  sleep.  Next  morning,  at  some 
convenient  time  after  breakfast,  the  child  is  sub- 
jected to  twenty  minutes'  massage.  The  inunctions 
are  continued  until  the  skin  becomes  soft  and  active, 
and  massage  is  employed  daily  until  there  is  a  de- 
cided improvement  in  the  amount  of  flesh  and 
general  strength — -a  period  generally  of  two  or  three 
weeks.  Afterward,  "movements"  every  third  day 
will  be  sufficient  to  complete  the  cure. 

In  these  cases  massage  not  only  aids  the  baths 
and  inunctions  in  their  general  action,  but  directly 
and  powerfully  increases  nutrition  and  muscle  force, 
and  materially  hastens  an  otherwise  slow  process  of 
recovery. 

(b)  Constipation.  Manipulation  is  a  very  effi- 
cient remedy  in  habitual  constipation,  and  there 
are  many  cases  that  can  be  cured  by  it,  combined 
with  a  properly  regulated  diet,  without  the  use  of 
drugs.  Petrissage  of  the  large  intestine  is  the  best 
method,  instructions  being  given  to  follow  the  natu- 
ral course  of  the  faeces  through  this  portion  of  the 
gut;  thus,  beginning  in  the  right  groin  to  proceed 
upward  to  the  lower  border  of  the  ribs  on  the  right 
side,  to  cross  over,  horizontally,  to  the  same  region 


MASSAGE  273 

on  the  left  side,  and  then  downward  to  the  left  groin. 
In  this  way  the  ascending  transverse  and  descending 
colon  are  manipulated  in  order. 

Five  or  ten  minutes  every  morning,  or  every 
morning  and  evening  in  obstinate  cases,  constitute 
the  proper  duration  and  frequency  of  the  manifesta- 
tions. The  pressure  must  be  gentle,  as  delicate 
underlying  tissues  are  being  dealt  with. 

In  this  condition  I  have  not  found  the  dry  method 
so  efficient  as  a  combination  of  massage  with  the 
inunction  of  warm  olive  oil. 

Sometimes  tapotement  with  the  flat  hand,  with  the 
hand  partly  closed  forming  a  cushion,  or  with  the 
margin  of  the  hand,  is  necessary,  but  the  course  of 
the  colon  must  always  be  followed.  The  beneficial 
action  of  this  mode  of  treatment  is,  undoubtedly, 
threefold;  it  increases  the  intestinal  and  other  se- 
cretions; it  increases  the  expulsive  action  of  the 
intestinal  muscular  fibers,  and  it  mechanically  forces 
accumulated  faecal  matter  toward  the  natural  gate 
of  exit. 

(c)  Colic.  Every  experienced  mother  knows  how 
often  "wind,"  the  cause  of  colicky  pain,  is  expelled 
from  the  stomach  or  intestines  by  gently  rubbing 
the  abdomen  with  the  hand.  Any  approach  to 
scientific  manipulation  is  much  more  efficient,  and 
two  or  three  minutes'  effieurage  may  be  resorted  to, 
as  the  urgency  of  the  symptoms  requires,  with  the 

18 


274  HYGIENE   OF   THE   NURSERY 

most  satisfactory  effect.  In  this  connection  it  must 
be  remembered,  also,  that  rubbing  of  the  feet  to 
increase  the  circulation  is  an  important  aid  in 
relieving  colic. 

(d)  General   debility    and   impoverished   blood. 
These   conditions   are  much    benefited  by  short, 
frequently  repeated  courses  of  massage.     In  the 
convalescence  from  many  diseases — both  acute  and 
chronic — the   above   conditions   are   present,    and 
manipulation,  by  improving  general  nutrition,  leads 
to  a  rapid  restoration  of  strength. 

(e]  Infantile    paralysis.     Here    massage    of    the 
paralyzed  muscles  brings  more  blood  into  them 
and  maintains  their  nutrition  until,  in  favorable 
cases,  new  nerve  cells  take  on  the  function  of  those 
which  have  been  destroyed. 

In  infantile  paralysis  the  affected  members  are 
always  cold,  and  the  muscles  contract  feebly,  if  at 
all,  under  the  influence  of  electricity.  By  system- 
atic massage — petrissage  combined  with  effleurage 
and  both  performed  centripetally — an  improvement 
takes  place"  with  more  or  less  rapidity.  The  first 
indication  of  this  is  an  increase  in  the  temperature 
of  the  parts,  continuing  for  several  hours  after  the 
rubbing.  Then  the  electrical  contractility  of  the 
muscles  begins  to  return,  and  they  respond  to  a 
battery- current  that  at  the  commencement  is  entirely 
inoperative. 


MASSAGE  275 

In  recent  cases  the  sittings  should  be  of  short 
duration  and  frequently  repeated,  five  to  ten  min- 
utes, three  or  four  times  daily.  As  improvement 
advances,  the  frequency  may  be  reduced,  and  in 
chronic  cases  twice  a  day  will  be  sufficient  at  any 
time. 

Electricity  is  of  great  aid  in  the  treatment,  but  it 
does  not  take  the  place  of  massage,  for  while  it 
causes  contraction  and  congestion  of  the  muscles 
and  an  accumulation  of  blood  in  the  skin,  it  does 
not  have  the  same  power  of  arresting  rapid  wasting. 
This  method  of  treatment  should  never  be  under- 
taken without  the  counsel  of  a  physician. 

(/)  St.  Vitus's  dance  (chorea).  So  far  as  this 
branch  of  the  management  of  chorea  is  concerned 
it  requires  to  be  aided  by  proper  diet  and  rest  in 
bed.  On  the  onset  of  an  acute  attack  the  patient 
is  put  to  bed,  given  a  full  supply  of  good  food,  and 
allowed  to  rest  for  two  days  without  massage. 
Should  the  jerking  movements  be  very  violent,  the 
sides  of  the  bed  are  padded  to  prevent  the  child 
bruising  himself,  or,  if  too  violent  for  this,  to  give 
security,  he  is  slung  in  a  hammock.  At  the  end 
of  this  time  the  regular  treatment  is  initiated.  (For 
diet  and  regimen  in  chorea  see  page  265.)  After 
two  or  three  weeks  of  full  feeding  and  rest  and 
massage  the  patient  should  be  able  to  sit  up  in  bed, 
well  supported  by  pillows,  and  may  have  a  few  toys 


276  HYGIENE   OF   THE   NURSERY 

to  play  with.  It  is  a  golden  rule,  however,  never  to 
hurry  a  patient  with  chorea  out  of  bed.  The  mus- 
cular strength  is  more  quickly  recovered  while  at 
perfect  rest,  and  too  early  exertion  often  causes  a 
relapse.  While  carrying  out  this  plan  appropriate 
medical  treatment  should  be  employed. 

(g)  Among  other  nervous  diseases  in  which 
massage  is  practised  with  success  are  facial  paraly- 
sis; neurasthenia  and  spinal  irritability  occurring 
in  girls  about  the  approach  of  puberty,  and  that 
painful  condition  of  rheumatic  origin  so  often  en- 
countered in  young  subjects  and  known  as  "grow- 
ing pains." 

(h)  Accumulations  of  watery  fluid  between  the 
lungs  and  the  chest  wall  (pleuritic  effusions),  en- 
larged glands,  and  stiffened  rheumatic  joints  are  all 
benefited  by  rubbing.  In  these  special  instances 
the  manipulations  are  generally  combined  with  the 
use  of  ointments  or  lotions,  though  the  curative 
effects  cannot  be  attributed  to  the  latter  alone. 

In  concluding  the  subject  of  massage  in  child- 
hood, it  is  a  point  of  importance  to  mention  that 
those  cases  in  which  the  manipulation  is  imme- 
diately followed  by  a  sensation  of  comfort  or  by 
refreshing  sleep  are  most  benefited  by  it.  On  the 
contrary,  those  cases  that  are  stimulated,  derive  little 
benefit,  and  perhaps  positive  injury  from  rubbing. 
This  I  have  especially  noted  in  cases  of  general 


MASSAGE  277 

debility  and  impoverished  blood,  and  my  own 
experience  has  been  confirmed  by  a  number  of 
practical  observers  in  whose  judgment  I  have  the 
greatest  confidence. 


CHAPTER  XI. 

EMERGENCIES. 

In  Chapter  I,  attention  was  directed  to  certain 
deviations  from  the  features  of  health  that  should 
lead  the  mother  or  nurse  to  suspect  the  onset  of 
disease.  In  addition  to  these,  it  is  of  great  service 
to  take  into  account  the  four  seasons  of  the  year, 
and  to  be  informed  of  what  diseases  generally  pre- 
vail during  each. 

In  the  late  fall  and  early  winter  catarrhal  affec- 
tions are  most  apt  to  occur.  In  catarrh  there  is 
an  increased  secretion  of  mucus  from  the  lining 
membrane  of  either  the  nose,  the  throat,  the  air- 
tubes  or  the  digestive  canal,  attended  by  fever,  loss 
of  appetite,  thirst  and  lassitude,  with  sneezing, 
hoarseness,  cough,  vomiting  or  diarrhoea,  accord- 
ing to  the  situation  of  the  disease. 

As  winter  advances,  the  bronchial  tubes,  the 
lungs  themselves  and  their  investing  membrane, 
the  pleurae,  are  liable  to  attack,  and  the  signs  of 
bronchitis,  pneumonia,  or  pleurisy  may  be  developed. 

In  the  changeable  weather  of  spring,  together 
with  the  catarrhal  inflammatory  disorders  already 

278 


EMERGENCIES  279 

mentioned,  epidemics  of  measles,  scarlet  fever, 
and  chicken-pox  are  most  prevalent;  while  during 
the  summer  months  disorders  of  the  bowels,  such 
as  diarrhcea,  " summer  complaint"  and  cholera 
infantum,  swell  the  mortality  lists  of  the  larger 
cities. 

Again,  the  influence  of  any  hereditary  tendency 
to  disease  should  always  be  present  in  the  mother's 
mind,  as  this  not  only  makes  her  alive  to  the  possi- 
bility of  the  onset  of  illness  and  leads  her  to  seek 
medical  advice  in  time,  but  also  induces  her  to 
shield  anxiously  her  child  from  known  exciting 
causes,  and  to  adopt  hygienic  measures  calculated 
to  overcome  the  constitutional  predisposition. 

In  considering  the  question  of  emergencies,  un- 
der which  term  will  be  included  both  accidents  and 
certain  conditions  of  disease,  no  reference  will  be 
made  to  the  management  of  serious  disorders. 
These,  even  in  their  earliest  stages,  must  receive 
the  attention  of  a  physician. 

ACCIDENTS  AND   DISORDERS    OCCURRING   AT 
BIRTH  OR  SOON  AFTER. 

INJURIES  RECEIVED  DURING  BIRTH. 

The  shape  of  the  head  is  sometimes  altered  by 
the  compression  it  is  subjected  to  during  a  pro- 
longed and  difficult  labor.  The  deformity  is  usu- 
ally in  the  direction  of  elongation,  the  distance 


280  HYGIENE   OF   THE   NURSERY 

from  the  chin  to  the  back  of  the  head  at  times 
measuring  six  inches  or  even  more.  There  is  no 
ground  for  apprehension  in  these  cases,  and  the 
head  will  regain  its  natural  shape  without  mechani- 
cal interference. 

Swellings  upon  the  scalp  are  quite  common. 
They  are  due  to  pressure  sustained  by  the  parts  in 
labor.  Such  tumors  gradually  subside,  if  kept  free 
from  compression  and  frequently  bathed  with  cool- 
ing lotions;  of  the  latter,  alcohol  and  water,  the 
extract  of  witch-hazel  and  water,  or  diluted  lead- 
water  are  serviceable. 

The  face  may  be  congested  and  blackened,  and 
the  features  disfigured  and  distorted  from  the  same 
cause.  A  natural  appearance,  however,  will  be 
recovered  in  a  few  days  without  any  treatment. 

BLEEDING  FROM  THE  NAVEL  STRING. 

This  serious  accident  occasionally  occurs  some 
hours  after  birth.  It  arises  from  the  cord  being 
carelessly  tied  or  from  its  being  unusually  large  at 
birth  and  subsequently  shrinking,  so  that  the  liga- 
ture ceases  to  close  the  blood-vessels. 

To  arrest  the  hemorrhage,  the  infant's  clothes 
and  flannel  binder  must  be  removed  and  the  cord 
exposed;  then  a  new  ligature,  composed  of  six 
strands  of  strong  linen  thread,  must  be  applied  half 
an  inch  nearer  the  body  than  the  original  one,  and 


EMERGENCIES  281 

tied  tightly   enough   to  compress   thoroughly    the 
vessels,  but  not  so  tight  as  to  cut  through  the  cord. 

ULCERATION  OF  THE  NAVEL. 

The  cord  generally  separates  from  the  navel 
between  the  fifth  and  fifteenth  day  after  delivery, 
and  the  parts  should  then  heal  without  trouble. 
Occasionally,  after  the  falling  of  the  cord,  a  small 
growth,  about  as  large  as  a  pea,  appears  on  the 
navel,  giving  rise  to  a  discharge  of  thin  liquid.  This 
may  be  relieved  by  applying  a  little  powdered  alum 
and  afterward  dressing  with  vaseline  or  oxide  of 
zinc  ointment. 

Again,  though  rarely,  excoriation  of  the  navel 
and  surrounding  skin  takes  place,  and  rapidly 
spreads,  assuming  an  inflammatory  character. 
The  attention  of  the  physician  must  be  called  to 
this  Apply  a  warm-water  dressing  should  his 
visit  be  delayed. 

SECONDARY  BLEEDING  FROM  THE  NAVEL. 

At  the  time  of,  or  several  days  after,  the  sepa- 
ration of  the  cord,  bleeding  may  take  place  from 
the  navel.  In  this  event,  which  is  fortunately  un- 
common, place  the  point  of  the  finger  over  the  part 
and  steadily,  but  gently,  press  it  until  medical  aid 
can  be  obtained. 

When  a  bleeding  growth  appears  at  the  navel, 


282  HYGIENE   OF   THE   NURSERY 

wind  a  piece  of  very  narrow  tape  closely  around  it 
and  leave  the  whole  undisturbed.  Under  these  cir- 
cumstances the  hemorrhage  quickly  stops  and  the 
growth  soon  sprouts  over  the  upper  edge  of  the  tape 
and,  strangulating  itself,  drops  off. 

YELLOW  STAINING  OF  THE  SKIN. 

During  the  first  few  days  of  life,  especially  after 
a  difficult  and  tedious  birth,  there  is  apt  to  be  intense 
congestion  of  the  skin,  followed,  as  the  redness  fades, 
by  a  brownish  yellow  discoloration.  This  usually 
disappears  by  the  tenth  day.  The  coloration  resem- 
bles that  of  true  jaundice,  but  there  is  no  yellow 
staining  of  the  whites  of  the  eyes,  nor  change  in 
the  color  of  the  urine  or  faeces.  Real  jaundice 
occasionally  occurs  and  is  a  serious  condition, 
requiring  careful  management. 

RETENTION  OF  URINE  AND  F^CES. 

Infants  frequently  do  not  pass  urine  for  many 
hours  after  birth,  sometimes  not  for  days.  This 
may  be  due  to  complete  want  of  secretion  or  to 
some  temporary  engorgement  of  the  kidneys,  which 
can  be  relieved  by  drawing  the  blood  to  the  surface 
by  immersion  in  a  warm  bath — a  procedure  to  be 
adopted  in  all  cases  in  which  no  urine  is  voided 
during  the  first  twenty-four  hours  of  life.  Often, 
in  lieu  of  the  bath,  it  will  suffice  to  lay  a  piece  of 


EMERGENCIES  283 

flannel,  wrung  out  of  hot  water,  upon  the  lower 
third  of  the  abdomen,  the  region  over  the  bladder. 
Occasionally  some  physical  malformation  leads 
to  retention  of  urine,  and  it  is  the  duty  of  the  nurse 
to  be  on  the  lookout,  so  that  she  may  early  call  the 
physician's  attention  to  the  matter.  The  same  con- 
dition may  also  prevail  in  the  bowel,  and  when 
twelve  hours  elapse  without  any  evacuation  the 
parts  ought  to  be  carefully  examined. 

SWELLING  OF  THE  BREASTS. 

At  birth,  or  within  the  following  day  or  two,  the 
mammary  glands  of  an  infant  may  swell,  become 
hard  and  painful,  and  secrete  a  thin  fluid  much 
resembling  milk.  Never  make  any  pressure  to  re- 
move the  secretion,  as  it  may  lead  to  inflammation. 
When  the  swelling  is  moderate,  judicious  inaction 
is  best,  but  in  severer  cases,  when  the  surface  is  red, 
and  the  parts  much  swollen,  and  hard  and  tender  to 
the  touch,  a  hot-water  dressing  must  be  constantly 
applied. 

INFLAMMATION  OF  THE  EYES. 

This  is  a  most  important  condition,  and,  from  the 
outset,  requires  the  attention  of  the  physician  and 
the  greatest  care  on  the  part  of  the  nurse. 

The  inflammation  usually  comes  on  about  three 
days  after  birth,  in  the  following  manner:  on  wak- 


284  HYGIENE    OF   THE   NURSERY 

ing  from  sleep,  the  child's  eyelids  are  slightly  glued 
together;  their  edges,  particularly  at  the  corners, 
are  redder  than  natural,  and  on  turning  down  the 
lower  lid  a  little  white  matter  will  be  observed 
on  the  inside.  Light  causes  pain  and  there  is  a 
tendency  to  keep  the  eyelids  closed.  After  a  short 
time  the  lids  swell,  become  red  on  their  external 
surfaces,  and  a  large  quantity  of  matter  is  secreted 
and  constantly  pours  from  the  eye.  Apart  from 
pure  medicinal  treatment  the  nurse  must  keep  the 
eye  free  from  discharge  by  constantly  washing  away 
the  matter  secreted  with  boric  acid  solution.  Burn 
the  cotton  used  in  this  process  at  once,  and  it  is 
most  important  for  the  attendant  not  to  carry  any 
of  the  discharge  to  her  own  eyes. 

HARELIP  AND  CLEFT  PALATE. 

These  are  deformities  requiring  the  attention  of 
the  surgeon,  and  under  ordinary  circumstances  his 
aid  should,  in  case  of  simple  harelip,  be  sought 
within  the  first  six  months  of  the  child's  life,  so  that 
the  operation  may  be  well  over  before  dentition 
begins.  The  fourth  month  is  the  period  of  election, 
but  should  there  be  difficulty  in  sucking  and  any 
evidences  of  inanition,  the  operation  may  be  per- 
formed at  an  earlier  age.  The  operation  for  cleft 
palate  should  not  be  undertaken  before  the  end  of 
the  second  year. 


EMERGENCIES  285 

So  far  as  the  mother  is  concerned,  the  question 
of  importance  is  whether  or  not  there  is  any  inter- 
ference with  the  act  of  sucking.  If  harelip  be 
trifling,  the  infant  will  be  able  to  suck,  provided  the 
mother's  nipple  be  large  and  the  milk  flow  freely; 
when  the  reverse  is  the  case,  resort  to  a  nipple 
shield.  In  grave  cases,  especially  when  harelip  is 
associated  with  cleft  palate,  the  child  is  unable  to 
suck  either  from  the  breast  or  from  the  bottle,  and 


FIG.  24. — TIP  WITH  FALSE  PALATE. 

must  be  fed  from  a  spoon.  Occasionally  one  can 
succeed  in  feeding  a  child  so  affected  from  a  bottle, 
by  resorting  to  a  false  palate.  This  consists  of  a 
bit  of  thin  india  rubber,  cut  the  size  and  shape  of 
the  roof  of  the  mouth  and  fastened  by  several  firm 
stitches  to  an  ordinary  bottle  tip  (Fig.  24).  In 
using  this  instrument,  the  nurse  must  insert  it  into 
the  mouth  in  such  a  way  that  the  rubber  diaphragm 
will  come  uppermost  and  bridge  over  the  imperfect 
portion  of  the  palate. 


286  HYGIENE    OF   THE   NURSERY 

TONGUE-TIE. 

In  this  condition  the  bridle  beneath  the  tongue 
is  either  too  short,  or  is  attached  so  near  the  tip  of 
the  tongue  as  to  interfere,  at  first,  with  the  move- 
ments of  the  organ  in  sucking,  and,  afterward,  in 
speaking.  Although  frequently  suspected,  it  in 
reality  occurs  very  rarely.  The  best  way  to  deter- 
mine if  tongue-tie  exist  or  not,  is  to  watch  whether 
the  infant  can  protrude  the  tip  of  the  tongue  beyond 
the  lips.  If  so,  it  will  be  able  to  suck  a  good  nipple 
readily,  and  nothing  need,  nor  ought,  to  be  done. 
Should  the  reverse  condition  prevail,  it  will  be 
necessary  to  nick  the  bridle,  and,  as  there  is  con- 
siderable danger  of  hemorrhage  in  this  operation,  a 
surgeon  must  always  be  consulted. 

ACCIDENTS   AND   DISORDERS    OCCURRING   IN 
INFANCY  AND  CHILDHOOD. 

BRUISES. 

A  contusion  or  bruise  must  be  treated  as  soon 
as  received,  if  one  would  relieve  pain,  lessen  swell- 
ing and  prevent  the  formation  of  a  black  and  blue 
spot.  Compresses  wet  with  hot  water,  a  light  ice 
bag,*  or  a  lotion  of  fluid  extract  of  witch-hazel,  are 
the  best  remedies.  A  bruise  upon  the  head  in  the 

*  Heat  and  cold  act  in  the  same  way  upon  the  blood-vessels, 
contracting  them  and  preventing  the  transudation  of  blood.  It 
is  the  changes  occurring  in  the  blood  after  leaving  the  vessels 
that  produce  the  discoloration. 


EMERGENCIES  287 

case  of  a  young  infant,  and  especially  when  followed 
by  paleness  and  vomiting,  is  not  to  be  carelessly 
overlooked,  since  it  is  sometimes  the  cause  of 
convulsions. 

SPRAINS. 

Do  not  make  light  of  a  severe  sprain,  for  the 
consequences  are  often  more  lasting  than  those  of  a 
broken  bone. 

Much  care  and  patience  will  be  required  in  the 
management  of  sprains,  the  great  point  being  to 
secure  rest  for  the  injured  part.  Should  the  knee 
or  ankle-joint  be  involved,  put  the  patient  to  bed 
and  swathe  the  part  in  a  hot-water  dressing,  or  in 
compresses  soaked  with  fluid  extract  of  witch- 
hazel.  When  a  joint  of  the  upper  extremity  is 
involved,  it  is,  of  course,  unnecessary  to  confine 
the  child  to  bed;  but  at  the  same  time  the  limb 
must  be  placed  in  such  a  position  as  to  be  as  quiet 
as  possible,  while  the  local  applications  already 
mentioned  should  be  employed.  Later,  passive 
motion  must  be  practised  in  order  to  prevent  per- 
manent stiffness.  A  sprain,  however,  needs  the 
surgeon's  attention  as  much  as  a  broken  bone. 

FRACTURES. 

The  breaking  of  a  bone  is  indicated  by  deformity 
of  the  limb,  such  as  bending,  shortening,  or  twist- 


288  HYGIENE    OF   THE   NURSERY 

ing,  and  when  this  occurs,  much  suffering  to  the 
patient  and  injury  to  the  part  may  be  saved  by  a 
little  careful  management.  In  lifting  the  child 
from  the  spot  where  the  accident  happens  and  carry- 
ing him  to  a  bed,  it  should  be  one  person's  duty  to 
support  tenderly  the  injured  limb,  instead  of  allow- 
ing it  to  dangle  loosely.  Once  in  bed,  lay  it  upon  a 
soft,  rather  broad  pillow;  double  this  around  the 
limb,  and  tie  up  tightly  so  as  to  afford  protection 
from  jars  or  shaking. 

Beyond  this,  nothing  should  be  undertaken  until 
the  physician  arrives,  except — in  case  of  fracture  of 
the  lower  extremity — the  preparation  of  the  bed. 
This  consists  in  arranging  a  firm,  though  not  too 
hard,  mattress,  with  two  or  three  under  blankets 
for  the  sake  of  warmth. 

CUTS. 

These  may  be  dean,  as  when  made  by  a  knife; 
torn,  by  a  broken  plate;  or  abraded,  by  a  fall  on 
hard,  rough  ground.  If  large  and  deep,  the  sur- 
geon should  be  called  at  once.  In  trifling  cases, 
the  nurse  must  first  thoroughly  cleanse  the  wound 
by  sponging  it  with  hot  water  and  then  with  an 
antiseptic  solution  of  bichloride  of  mercury,  I 
part  to  3000,  using  a  ball  of  absorbent  cotton  for 
a  sponge.  Any  flow  of  blood  should  be  checked 
by  pressure,  by  the  application  of  hot  water,  or — 


EMERGENCIES  289 

should  the  hemorrhage  be  obstinate — by  the  use  of 
a  solution  of  alum.  In  the  case  of  a  knife  cut,  the 
next  step  is  to  press  the  edges  together,  fix  them  in 
this  position  by  applying  narrow  strips  of  surgeon's 
adhesive  plaster  at  short  intervals  across  the  wound, 
and  cover  the  whole  with  antiseptic  gauze.  A 
torn  wound  may  be  dressed  in  the  same  way,  but 
greater  care  is  required  to  coadapt  the  edges.  For 
abrasions,  the  best  application  is  a  piece  of  lint 
or  absorbent  cotton  saturated  with  the  bichloride 
solution  already  mentioned,  fixed  by  a  bandage. 
Neither  dressing  need  be  removed  unless  disar- 
ranged or  in  the  event  of  suppuration  taking  place; 
in  the  latter  case  the  wound  must  be  washed  with 
the  antiseptic  solution  and  redressed  each  day. 
When  an  artery  is  cut,  the  flow  of  blood  must  be 
checked  by  pressure  on  the  vessel  above  the  seat  of 
injury;  in  the  case  of  a  vein,  below  it.  Arterial 
blood  flows  in  jets  and  is  scarlet;  venous  blood  runs 
in  a  continuous  stream  and  is  purple  in  color. 

It  is  most  important  to  remember  that  the  bichlo- 
ride solution  is  an  active  poison  and  that,  conse- 
quently, it  must  be  most  carefully  handled  and 
guarded.  It  should  be  kept  in  a  blue  bottle  labeled 
" Poison,"  and  never  left  where  there  is  the  slight- 
est risk  of  its  being  tasted  and  swallowed  by  the 
child  or  attendants,  and  never  placed  with  the  ordi- 
nary nursery  medicines. 


2  go  HYGIENE   OF   THE   NURSERY 

BURNS  AND  SCALDS. 

The  danger  from  burns  or  scalds  is  in  direct  pro- 
portion to  the  extent  of  surface  involved  and  the 
depth  of  tissue  destroyed.  Fortunately,  the  ma- 
jority of  cases  are  trifling,  and  usually  the  hands  or 
face  are  the  parts  that  suffer.  In  these  instances 
there  are  two  things  to  be  done:  first,  to  relieve 
pain,  and  second,  to  encourage  healing.  To  accom- 
plish the  former,  apply  a  saturated  solution  of 
baking  soda;  for  the  latter  use  some  mild  ointment 
— fresh  lard,  for  example — and  keep  the  injured 
part  protected  from  the  air  by  a  dressing  of  cotton 
batting. 

Should  the  child's  clothing  take  fire,  remember 
that  an  upright  position  not  only  favors  the  spread 
of  the  flames,  but  encourages  their  approach  to  the 
neck  and  head.  Any  movement  of  the  body,  too, 
aids  the  flames  by  bringing  fresh  currents  of  air  in 
contact  with  the  burning  materials.  Therefore,  do 
not  let  the  child  run  about,  but  seize  him,  throw 
him  down  upon  the  floor  and  envelop  his  body 
closely  in  the  hearth  rug  or  a  woolen  tablecloth. 

Should  the  child  have  fallen  into  a  tub  of  scald- 
ing water,  remove  him  immediately,  of  course,  and 
undress  him.  In  taking  off  the  clothing,  be  careful  to 
do  it  so  gently  as  not  to  break  the  blisters  produced 
by  the  moist  heat;  and  should  the  underclothing 
stick  anywhere  to  the  surface,  the  garments  must 


EMERGENCIES  2QI 

be  cut  away  piecemeal,  leaving  the  adherent  por- 
tions untouched. 

After  the  above  preliminaries  put  him,  in  either 
case,  at  once  to  bed.  Next,  prepare  a  number  of 
pieces  of  old  muslin  corresponding  in  size  with  the 
injured  areas,  spread  these  with  fresh  lard  or  cosmo- 
line,  apply  them  and  cover  all  with  a  thick  layer  of 
cotton  batting  and  fix  with  bandages.  Should  the 
patient  complain  of  cold  hands  or  feet,  or  of  faint- 
ness,  a  little  whiskey  or  brandy  may  be  adminis- 
tered and  artificial  heat  applied  to  the  extremi- 
ties if  these  be  uninjured.  Nothing  else  should 
be  done  without  the  physician. 

STINGS  OF  INSECTS. 

Children,  being  more  ignorant,  are  more  fre- 
quently stung  by  bees,  wasps,  and  other  insects, 
than  adults.  Examine  the  wound  the  first  thing 
with  a  magnifying  glass,  and  if  the  sting  be  still  in 
the  tissues,  extract  it  with  a  pair  of  tweezers,  or 
squeeze  it  out  by  firm  pressure  in  the  neighborhood 
of  the  puncture.  After  this,  apply  aromatic  spirits 
of  ammonia  or  eau  de  Cologne.  These  will  relieve 
the  pain  and  itching.  When  the  sting  produces 
great  pain  and  inflammation,  apply  a  flaxseed  poul- 
tice for  twenty-four  hours.  The  frequent  use, 
afterward,  of  camphorated  soap  liniment  will  be 
productive  of  good  results. 


2Q2  HYGIENE    OF    THE   NURSERY 

FOREIGN  BODIES  IN  THE  EAR. 

When  a  foreign  substance  has  entered  the  ear, 
the  plan  for  its  extraction  depends  somewhat  upon 
the  nature  of  the  material.  In  any  case,  however, 
bend  the  child's  head  toward  the  affected  side, 
cause  him  to  open  his  mouth  as  wide  as  possible, 
and  at  the  same  time  gently  pull  the  external  ear 
upward  and  backward.  In  this  way  the  external 
canal  of  the  ear  is  straightened  and  stretched  to  its 
widest  extent,  and  a  small  body  like  a  bead  may 
drop  out.  Another  method  is  to  wash  the  foreign 
body  away  with  warm  water  and  a  syringe.  Should 
the  substance  be  of  a  nature  to  increase  in  size  by 
absorbing  moisture,  such  as  a  pea  or  bean,  its 
extraction  must  be  left  for  the  physician,  though 
it  is  to  be  delayed  no  longer  than  absolutely  neces- 
sary. When  an  insect  enters  the  ear,  the  external 
canal  must  at  once  be  filled  with  fresh  olive  oil. 

FOREIGN  BODIES  IN  THE  EYE. 

A  simple  plan  for  removing  cinders  and  the  like 
from  the  eye  is  to  pull  the  upper  eyelid  forward  and 
downward,  by  grasping  the  eyelashes,  and  direct 
the  child  to  look  upward.  In  this  way  the  lashes  of 
the  lower  lid  are  made  to  sweep  over  the  inside  of 
the  upper  one,  and  thus  may  brush  away  the  foreign 
body.  If  this  be  unsuccessful,  and  if  the  offending 


EMERGENCIES  293 

substance  be  in  sight,  remove  it  with  the  corner  of 
a  fine  handkerchief.  If  not  seen  on  the  eyeball,  it 
must  be  looked  for  beneath  the  lids.  It  is  easy 
enough  to  pull  down  the  lower  lid  and  examine  its 
internal  surface;  in  the  case  of  the  upper  lid,  how- 
ever, it  is  necessary  to  perform  eversion;  this  is 
done  by  drawing  the  lid  downward  and  forward,  and 
turning  it  over  a  thin  lead  pencil  (Fig.  25).  Direct 


FIG.  25. — METHOD  OF  EVERTING  UPPER  EYELID. 

the  child,  in  the  meanwhile,  to  look  down.  When 
the  intruding  body  is  disclosed  by  this  process,  it 
may  be  brushed  away  by  a  little  cotton  twisted 
upon  the  end  of  a  match  stick,  or  by  a  small  camePs- 
hair  brush;  the  touch  must  be  very  gentle,  and  no 
prolonged  effort  made  if  the  mote  be  imbedded. 
Treat  any  slight  irritation  following  this  accident 
and  the  process  of  removal  by  frequent  appli- 
cations of  hot  water. 


294  HYGIENE    OF   THE   NURSERY 

FOREIGN  BODIES  IN  THE  NOSE. 

Children  frequently  insert  shoe-buttons,  peas, 
beans,  and  other  small  objects  into  the  nose.  When 
these  are  not  too  firmly  fixed,  or  have  not  been 
pushed  too  far  up,  they  may  be  removed  by  closing 
the  opposite  nostril  and  causing  the  child  to  blow 
his  nose  forcibly.  Should  any  difficulty  be  expe- 
rienced, it  is  better  to  consult  a  physician  than  use 
persistent  force. 

FOREIGN  BODIES  IN  THE  THROAT. 

A  large,  unchewed  mass  of  food,  a  fish-bone,  or 
some  metallic  substance,  such  as  a  piece  of  money, 
may  become  lodged  at  some  point  in  the  throat. 

When  this  occurs,  immediately  insert  the  finger 
and  thumb  into  the  mouth,  pass  them  as  far  down 
the  gullet  as  possible,  and  if  any  object  be  felt,  make 
an  attempt  to  pull  it  forth. 

Instead  of  lodging  in  the  upper  part  of  the  gul- 
let, the  foreign  body  may  be  arrested  midway  in  its 
course  to  the  stomach.  Let  the  child  then  partially 
masticate  and  swallow  a  piece  of  bread  and  several 
mouthfuls  of  water,  which  will  probably  assist  the 
object's  passage  into  the  stomach;  if  not,  medical 
skill  will  be  required. 

Foreign  bodies,  such  as  buttons  and  coins,  and 
even  needles  and  pins,  that  pass  directly  into  the 


EMERGENCIES  295 

stomach,  give  rise  to  little  trouble,  and  soon  find 
their  way  through  the  alimentary  canal,  and  are 
voided  from  the  rectum  with  the  ordinary  faecal 
evacuations.  Laxative  medicines  are  never  to  be 
used  unless  the  bowels  be  absolutely  confined,  and 
then  moderate  doses  of  castor  oil  are  the  most 
suitable. 

BLEEDING  FROM  THE  NOSE. 

Hemorrhage  from  the  nose  is  sometimes  so  ex- 
cessive as  to  lead  to  debility,  or  even  threaten  serious 
results.  An  injury  or  abrasion  of  the  lining  mucous 
membrane  is  the  usual  cause  of  hemorrhage,  though 
it  may  result  from  certain  constitutional  conditions. 
To  arrest  the  bleeding,  put  the  child  upon  a  bed, 
with  the  head  and  shoulders  well  elevated.  First 
make  pressure,  with  the  thumb  and  index  finger,  on 
the  root  of  the  nose,  i.  e.,  that  portion  between  the 
eyes,  or  on  either  side  of  the  nostrils  where  the 
blood-vessels  ascending  from  the  lip  are  felt  to 
pulsate.  Should  this  fail,  plug  the  nostril  from 
which  the  blood  flows  with  a  cone-shaped  pledget 
of  absorbent  cotton  or  lint;  this  may  either  be  dry 
or  saturated  with  a  solution  of  alum  and  water  as 
hot  as  can  be  borne.  The  inhalation  of  the  vapor 
of  spirits  of  turpentine,  or  the  immersion  of  the 
feet  and  legs  in  a  hot  mustard  foot  bath,  are  each 
successful  in  some  cases.  If  the  bleeding  be  obsti- 


2p6  HYGIENE    OF   THE   NURSERY 

nate,  apply  a  piece  of  ice  wrapped  in  flannel  to  the 
forehead  or  the  back  of  the  neck. 

EARACHE. 

Earache  is  a  very  common  cause  of  crying  in 
infancy  and  childhood.  Screaming  from  earache 
may  be  distinguished  from  that  due  to  pain  in  the 
bowels,  another  fruitful  source  of  crying,  by  the 
former  being  more  continuous,  and  by  the  child 
frequently  carrying  his  hand  to  his  head;  again,  in 
earache  the  passages  from  the  bowels  are  natural, 
while  in  bowelache  they  are  usually  altered  in 
character  and  offensive. 

Douche  the  ear  gently  with  hot  boiled  water  or 
normal  saline  solution  and  put  into  the  ear,  for  a 
short  distance,  a  small  piece  of  absorbent  cotton 
saturated  with  a  four  per  cent,  solution  of  cocaine. 
At  the  same  time  dry  or  moist  heat  may  be  applied 
to  the  external  ear. 

COLDS  AND  COUGHS. 

A  cold  in  the  head  is  indicated  by  water  eyes, 
sneezing — with  a  discharge  of  mucus  from  the  nose 
— and  a  nasal  voice.  Simple  remedies  are  often 
efficacious.  Frequently  grease  the  forehead  and 
bridge  of  the  nose  with  mutton  suet;  insert  a  little 
vaselin  in  the  nasal  orifices,  and,  should  the  skin 
be  hot,  administer  a  mustard  foot  bath. 


EMERGENCIES  297 

An  ordinary  cold — or,  in  medical  language,  a 
bronchial  catarrh — is  usually  preceded  by  a  cold 
in  the  head,  and  is  indicated  by  a  hoarse  cough,  in- 
creased rapidity  of  breathing,  and  fever. 

The  methods  recommended  for  cold  in  the  head 
are  also  useful  here.  In  addition,  rub  the  chest 
thoroughly,  three  times  a  day,  with  a  liniment  of 
turpentine  and  sweet  oil,  one  part  to  three;  keep 
the  child  in  one  room  at  a  temperature  of  72°  F.; 
allow  a  light  diet,  and  summon  medical  aid. 

SPASMODIC  CROUP. 

In  this  condition  there  is  a  mild  grade  of  catarrh 
of  the  lining  mucous  membrane  of  the  larynx,  accom- 
panied by  marked  spasm  of  the  laryngeal  muscles. 
This  spasm  is  an  outcome  of  the  excessive  reflex 
nervous  irritability  common  to  young  children  and 
gives  rise  to  the  characteristic  features  of  the 
disease. 

Spasmodic  croup  may  occur  during  the  first  six 
months  of  life,  but  is  most  frequent  from  this  age 
up  to  the  third  year,  when  the  tendency  gradually 
diminishes  until  after  the  fifth  year  attacks  are 
unusual.  While  it  occurs  in  both  healthy  and 
delicate  subjects,  some  children  possess  a  peculiar 
susceptibility,  in  which  heredity  seems  to  play  a 
part.  One  attack  predisposes  to  others.  The 


298         HYGIENE  OF  THE  NURSERY 

exciting  causes  are  exposure  to  cold,  dampness, 
and  high  winds,  overeating,  and  indigestion  and 
constipation. 

An  attack  may  come  on  suddenly  or  be  preceded 
by  hoarseness  or  by  the  symptoms  of  nasal  catarrh. 
The  precedent  symptoms  usually  appear  about 
midday  and  gradually  increase.  As  evening  ap- 
proaches an  occasional  hollow,  barking,  evidently 
painful  cough  is  noticed  and  the  voice  is  very  hoarse; 
toward  midnight  the  cough  becomes  more  brazen 
and  more  frequent  and  the  breathing  difficult.  In 
very  mild  cases  these  disturbances  are  not  severe 
enough  to  wake  the  child,  but  when  the  laryngeal 
spasm  is  marked,  respiration  becomes  very  labored, 
especially  the  inspiratory  movement,  which  is  at- 
tended by  a  hissing  sound  and  by  visible  retraction 
of  the  soft  parts  above  and  below  the  breast-bone. 
Terrified  by  the  want  of  air  the  child  sits  up  in  bed 
and  struggles  for  breath.  The  face  has  an  anxious 
expression;  the  cheeks  are  flushed,  although  the 
lips  may  be  bluish,  and  the  forehead  is  covered  with 
drops  of  perspiration.  The  breathing  is  slow  and 
labored  and  any  excitement  or  effort  increases  the 
difficulty.  The  voice  is  hoarse  but  not  lost.  The 
cough  has  a  characteristic  brazen  tone.  The  pulse 
is  increased  in  frequency,  and  while  the  tempera- 
ture may  remain  normal  it  is  usually  moderately 
elevated. 


EMERGENCIES  2QQ 

If  untreated  such  an  attack  slowly  disappears, 
and  in  the  course  of  three  or  more  hours  the  child, 
exhausted,  drops  to  sleep.  Next  day,  with  the  ex- 
ception of  hoarseness  and  an  occasional  barking 
cough,  nothing  seems  amiss;  but  in  the  late  after- 
noon or  near  midnight  the  spasm  returns  and  is 
even  more  severe  than  before,  and  after  a  second 
free  day  is  apt  to  be  repeated  on  the  succeeding 
night,  although  this  third  attack  is,  as  a  rule,  much 
less  severe  than  the  others. 

The  treatment  of  an  attack  of  croup  must  be 
left  to  the  physician,  but  a  mother  can  do  much  in  the 
way  of  prevention.  When  the  susceptibility  exists, 
the  child  must  be  carefully  guarded  against  exposure 
to  cold,  high  wind  and  dampness;  must  be  properly 
fed,  never  allowed  to  become  constipated,  and 
everything  known  to  induce  an  •  attack  must  be 
rigidly  avoided.  Plenty  of  outdoor  life  and  fresh 
air,  under  proper  restrictions,  are  to  be  recom- 
mended. All  local  excitant  conditions — as  adenoid 
growths  or  hypertrophied  tonsils — should  receive 
attention,  and  if  there  be  general  ill  health  and  want 
of  tone,  the  system  should  be  built  up  by  food  and 
tonics. 

Upon  the  onset  of  hoarseness  and  a  croupy  cough, 
syrup  of  ipecacuanha  should  be  given  in  doses  of 
3  to  5  drops  in  a  little  sweetened  water  every  two 
hours,  and  the  throat  and  anterior  part  of  the  chest 


300  HYGIENE    OF   THE   NURSERY 

thoroughly   rubbed    with    camphorated    oil    every 
four  hours. 

When  an  attack  occurs — before  the  arrival  of  the 
physician — hot  compresses  should  be  applied  to 
the  region  of  the  larynx,  and  sufficient  syrup  of 
ipecacuanha  administered  to  secure  free  emetic 
action,  and  in  this  way  relax  the  laryngeal  spasm — 
15  to  20  drops  every  fifteen  minutes,  for  three  or 
four  doses,  with  intermediate  draughts  of  warm 
water,  will  usually  accomplish  the  result  quickly. 
At  the  same  time  moistening  the  air  of  the  chamber 
with  vapor  from  a  croup-kettle  will  add  greatly  to 
the  comfort  of  the  patient;  or  better,  a  canopy  or 
tent  may  be  placed  over  the  bed  and  the  steam 
introduced  beneath  this. 

VOMITING. 

The  most  healthy  infant,  even  though  it  be  fed 
at  a  normal  breast,  often  expels  a  portion  of  each 
feeding.  This  is  an  act  of  regurgitation  rather  than 
vomiting,  and  is,  in  reality,  a  natural  method  of 
relieving  an  overburdened  stomach. 

Vomiting  proper  is  preceded  by  the  sensation  of 
nausea;  is  followed  by  lassitude,  and  is  often  at- 
tended by  fever.  It  indicates  some  disorder  of  the 
stomach.  For  its  relief,  perfect  rest  for  the  whole 
body;  several  hours'  starvation,  or  rest  for  the 


EMERGENCIES  301 

stomach,  and  a  reduction  in  the  quantity  and 
strength  of  the  food,  are  necessary.  Bits  of  ice, 
soda-mint,  lime-water,  and  a  mixture  of  equal  quan- 
tities of  cinnamon-water  and  lime-water,  in  tea- 
spoonful  doses,  are  simple  and  efficient  remedies;  a 
weak  mustard  plaster  placed  over  the  pit  of  the 
stomach  is  always  useful.  Should  the  symptom  be 
obstinate,  however,  the  case  becomes  too  serious  for 
the  mother  to  manage  on  her  own  responsibility. 

COLIC. 

Colic  is  a  very  common  affection  of  infancy.  It 
usually  occurs  in  the  period  between  birth  and  the 
end  of  the  third  month,  and  gives  rise  to  much  dis- 
comfort, both  to  the  infant  and  its  attendants,  by 
causing  fretfulness,  crying  and  wakefulness.  The 
treatment  is  very  much  one  of  careful  regula- 
tions of  the  diet.  Still,  there  are  some  domestic 
remedies  which  may  be  used  safely  and  with  suc- 
cess. Thus,  the  abdomen  should  be  anointed  twice 
a  day  with  warm  olive  oil  and  enveloped  in  a  broad 
flannel  binder.  It  is  even  more  important  to  keep 
the  feet  warm,  and  for  this  purpose  thick  socks  or 
long  woolen  stockings  should  be  worn,  and,  in  bad 
cases,  artificial  heat  must  be  applied  by  hot-water 
bottles.  Medicines  are  indicated  chiefly  during 
attacks  of  pain.  A  serviceable  prescription  is  ten 


302  HYGIENE    OF   THE   NURSERY 

drops  of  gin  in  a  teaspoonful  of  sweetened  warm 
water,  or  a  small  teaspoonful  of  hot  soda-mint.  It 
is  also  well  to  administer  five  to  ten  drops  of  essence 
of  pepsin  or  of  diazyme  essence  after  each  nursing. 
When  a  paroxysm  of  pain  is  violent  enough  to 
lead  to  depression  of  the  fontanelle  and  threaten 
collapse,  place  the  infant  in  a  warm  bath  for  five 
minutes.  After  removing  and  carefully  drying 
him,  wrap  him  in  a  blanket;  put  a  flax-seed  poultice 
with  a  little  mustard  flour  over  the  abdomen;  apply 
a  hot- water  bottle  to  the  feet;  relieve  the  bowels  by 
an  enema  of  warm  saline  solution,  and  by  the  mouth 
give  him  ten  drops  of  gin  or  brandy  in  warm  water. 
If  the  fontanelle  still  remains  depressed,  continue 
the  stimulant  in  doses  and  at  intervals  proportioned 
to  the  urgency  of  the  symptoms. 

CONSTIPATION. 

Habitual  constipation  is  such  a  common  occur- 
rence in  infancy  and  childhood  that  it  warrants  a 
somewhat  detailed  consideration.  The  methods 
that  may  safely  be  employed  to  clear  the  lower 
bowel  of  accumulated  faeces,  or,  in  other  words,  to 
relieve  the  actual  state  of  constipation,  will  be  first 
noticed,  for  this  is  always  a  necessary  step  when 
there  is  painful  straining,  and  in  case  there  has  been 
no  movement  for  a  day  or  more.  For  this  purpose 


EMERGENCIES  303 

injections  are  most  efficient,  and  when  given  with 
care  are  entirely  free  from  danger. 

A  serviceable  plan  is  to  inject  into  the  rectum, 
according  to  the  age  of  the  patient,  from  one  to  four 
teaspoonfuls  of  warm  olive  oil;  allow  it  to  remain 
for  six  hours,  and  then  use  one  or  more  injections 
of  normal  saline  solution.  The  preliminary  in- 
jection of  oil  softens  the  faeces,  while  the  subsequent 
ones  have  the  additional  effect  of  distending  the 
walls  of  the  rectum,  thus  bringing  about  muscular 
contraction  and  expulsion  of  its  contents.  Should 
a  compact  faecal  mass  be  present  at  the  anus  and 
be  too  bulky  to  escape — a  condition  often  visible 
during  straining — more  liquid  must  be  injected, 
and  if  this  fails  the  mass  must  be  broken  up  by  the 
finger  and  its  passage  assisted  by  gentle  pressure 
upon  the  parts  behind  the  anus  while  expulsive 
efforts  are  being  made.  The  process  of  breaking 
up  is  easy,  as  the  anus  is  widely  distended  at  such 
times.  In  obstinate  cases  little  result  may  follow 
a  single  employment  of  the  injections,  though  a 
course  of  one  or  two  oil  injections  and  purgative 
enemata  for  several  successive  days  rarely  fails  to 
empty  the  bowel. 

The  best  syringe  for  children  is  one  of  hard  rubber 
with  a  long,  smooth  nozzle,  having  a  capacity 
of  six  or  eight  fluidounces.  When  oil  is  injected, 
the  intention  being  to  have  it  remain  in  the  rectum 


304  HYGIENE    OF   THE   NURSERY 

and  act  mechanically  on  the  faeces,  its  retention  is 
best  secured  by  firmly  pressing  a  warmed  pad  of 
flannel  against  the  anus  for  five  minutes  after  the 
insertion,  the  patient,  in  the  meanwhile,  lying  upon 
his  back.  The  laxative  enemata  must  vary  in  bulk 
with  the  age  of  the  child,  or,  in  other  words,  with 
the  capacity  of  the  rectum;  two  fluidounces  (four 
tablespoonfuls)  will  be  sufficient  for  an  infant  of  six 
weeks,  while  from  four  to  eight  fluidounces  are 
required  at  the  age  of  two  years.  The  quantity  of 
salt  to  be  used  must  depend  upon  the  quantity  of 
water — half  a  teaspoonful  of  salt  to  eight  ounces  of 
water  being  the  proper  proportion.  After  drawing 
the  fluid — which  must  be  tepid — into  the  syringe, 
grease  the  nozzle  well  and  gently  insert  it  into  the 
anus,  directing  the  point  a  little  toward  the  patient's 
left;  next  slowly  force  down  the  piston  until  all  the 
liquid  is  expelled  or  complaints  of  pain  indicate  that 
the  bowel  is  sufficiently  distended.  If  it  be  possible 
to  secure  retention  for  a  moment  or  two  by  pressure 
on  the  anus,  the  movement  will  be  freer  and  easier 
than  if  the  fluid  be  allowed  to  flow  away  at  once. 
The  best  positions  for  the  child  are  either  on  his 
back  with  his  legs  well  drawn  up,  or  resting  on  his 
abdomen  across  the  nurse's  lap. 

Injections  of  glycerin  and  glycerin  suppositories 
are  also  very  useful  for  the  purpose  of  unloading 
the  lower  bowel.  When  glycerin  is  employed, 


EMERGENCIES  305 

the  quantity  to  be  injected  varies  from  one  to  two 
teaspoonfuls,  according  to  the  age  of  the  child, 
and  should  be  diluted  with  an  equal  quantity  of 
pure  water.  The  best  instrument  to  use  is  the  bulb 
syringe,  previously  recommended  (page  256). 

For  the  prevention  of  further  constipation  the 
diet  must  be  regulated  according  to  the  rules  given 
in  Chapter  IX,  and  besides  regulating  the  food  and 
hours  for  meals,  bathing,  sleep,  exercise  and  cloth- 
ing, care  must  be  taken  to  establish  fixed  habits  of 
defecation.  In  my  experience  very  young  infants 
can  be  taught  to  use  a  chamber,  and  if  this  vessel  be 
presented  each  day  at  the  same  hour  he  soon  falls 
into  regular  ways. 

The  training  should  be  begun  after  the  fourth  or 
fifth  week  in  the  following  way:  every  morning  and 
evening,  at  a  fixed  hour  after  feeding,  the  nurse 
places  a  small  chamber  between  her  knees,  and  upon 
this  holds  the  infant  with  its  back  against  her  chest 
and  its  body  firmly  supported.  Then  to  excite 
expulsive  efforts  and  suggest  the  object  of  the 
position,  a  soap-stick  is  inserted  a  short  distance 
within  the  rectum.  Soon,  however,  the  local 
irritation  becomes  unnecessary,  the  position  alone 
being  sufficient  to  quickly  ensure  an  evacuation. 
Should  faulty  habits  be  established  or  constipation 
exist,  resort  to  injections  and  abdominal  massage  at 
the  same  hour  each  day. 

20 


306  HYGIENE   OF   THE   NURSERY 

After  the  third  year  the  best  period  of  the  day 
for  the  bowel  to  be  moved  is  immediately  after 
breakfast,  and  no  call  of  duty  or  pleasure  should 
be  allowed  to  interfere.  When  constipation  is  to 
be  overcome  natural  efforts  must  be  made  then. 
These  efforts  may  at  first  be  ineffectual,  but 
much  can  be  accomplished  by  perseverance  in  a 
daily,  sustained  effort,  for  about  ten  minutes. 
When  this  plan  fails,  use  injections  or  other 
methods  of  relief,  taking  care  to  keep  to  a  cer- 
tain hour,  that  the  formation  of  a  habit  may  be 
encouraged. 

Thorough  rubbing  of  the  abdomen  is  often  suc- 
cessful in  inducing  a  movement  of  the  bowels. 
Gentle  pressure  should  be  made  with  the  palm  of 
a  well-warmed  hand,  and  the  movement  directed, 
first,  from  the  brim  of  the  pelvis  on  the  right  side, 
upward  to  the  rib  margin,  then  across  from  the 
right  to  the  left,  and  finally  downward  on  the  left 
side  from  the  margin  of  the  ribs  to  the  brim  of 
the  pelvis  again.  Such  manipulation  excites  peris- 
taltic action,  and  encourages  the  passage  of  the  in- 
testinal contents  along  the  large  bowel  toward  the 
anus.  Ten  minutes  is  quite  long  enough  to  continue 
the  rubbing.  The  manipulation  may  be  rendered 
more  effective  by  using  warm  sweet  oil  as  an  in- 
unction. 

With  children  of  six  years  and   upward,    daily 


EMERGENCIES  307 

cold  spongings  of  the  body  are  very  beneficial, 
followed  by  frictions  with  a  coarse  towel  until  the 
surface  is  red. 

Manna,  phosphate  of  sodium,  and  gluten  or  soap 
suppositories  are  among  the  medicines  that  may  be 
safely  used  in  the  nursery. 

Manna,  which  imparts  a  sweet  taste,  may  be 
dissolved  in  the  food,  and  given  from  the  bottle  as 
often  as  required;  a  piece  as  big  as  a  pea,  once, 
twice,  or  three  times  a  day,  will  be  sufficient  for  an 
infant  of  six  months. 

Phosphate  of  sodium — an  admirable  laxative — 
can  also  be  administered  with  the  food;  five  or  ten 
grains,  three  times  daily,  is  the  proper  dose  at  the 
same  age. 

Soap  suppositories  must  vary  in  strength  with  the 
age.  At  two  months  one  grain  of  castile  soap  to  ten 


FIG.  26. — SOAP  STICK. 

grains  of  cocoa  butter  is  the  proper  proportion;  at 
one  year  the  quantity  of  soap  may  be  increased  to 
five  grains  in  each  suppository,  and  so  on.  A 
substitute  for  soap  suppositories  may  be  prepared 
in  the  nursery,  as  follows:  Cut  from  a  bar  of  good 


308  HYGIENE    OF    THE   NURSERY 

castile  soap  a  piece  two  inches  long  and  half  an 
inch  thick.  Scrape  this  into  a  cone,  pointing  one 
end  like  a  sharpened  pencil,  but  with  a  blunter 
point  and  more  gradual  slope;  make  it  quite 
smooth  by  rubbing  the  surface  with  a  wet  rag  (Fig. 
26).  When  the  soap  stick  is  used  anoint  the  pointed 
end  with  vaseline  and  gently  insert  it  into  the  rectum 
and  hold  it  there  until  the  action  begins.  It  is  not 
desirable  to  leave  any  fragments  of  soap  in  the 
rectum.  Glycerin  suppositories  are  very  efficient, 
but  are  too  irritating  for  continuous  use. 

CONVULSIONS. 

Convulsions  arise  from  so  many  diverse  causes 
that  it  is  impossible  to  indicate  more  than  what  is 
to  be  done  during  the  fit  and  prior  to  the  arrival 
of  the  physician. 

When  the  attack  comes  on,  the  child  must  be 
undressed  at  once  and  plunged  into  a  hot  bath 
for  five  minutes;  this  bath  must  contain  enough 
mustard  flour  to  stimulate  the  skin  thoroughly. 
This  usually  restores  consciousness  and  checks  the 
muscular  twitching.  Should  there  be  a  distinct 
history  of  overloading  of  the  stomach,  give  an 
emetic  of  ipecacuanha,  and  after  this  has  operated, 
a  purgative  dose  of  castor  oil.  One  or  more  doses 
of  bromide  of  potassium,  five  to  ten  grains,  accord- 


EMERGENCIES  309 

ing  to  the  age,  may  also  be  safely  given;  this  salt 
must  always  be  administered  in  solution. 


A  CHILL. 

This  is  always  a  serious  occurrence  and  warrants 
sending  for  the  doctor.  Before  his  arrival,  put  the 
child  to  bed,  surround  him  with  bottles  containing 
hot  water,  place  a  moderately  strong  mustard  plas- 
ter over  the  abdomen  or  over  the  region  of  the 
heart,  and  administer  whiskey  and  hot  water  in 
small  doses  and  at  short  intervals. 

The  ailments  of  children  do  not  so  frequently 
begin  with  a  chill  as  do  those  of  adults,  but  when 
they  do,  it  is  a  more  decided  indication  of  the 
future  gravity  of  the  attack. 

FEVER. 

It  is  not  my  intention  here  to  refer  to  the  man- 
agement of  the  essential  fevers,  for  I  hold  that 
neither  mother  nor  nurse  is  capable  of  managing 
them  without  professional  assistance.  However, 
the  following  tables,  exhibiting  the  features  of 
the  eruptive  fevers  and  other  contagious  diseases, 
will  answer  some  of  the  questions  which  so  fre- 
quently suggest  themselves  to  the  minds  of  anxious 
parents. 


3io 


HYGIENE   OF   THE   NURSERY 

ERUPTIVE  FEVERS. 


Name. 

Period 
of  in- 
cuba- 
tion. 

Day  of 
rash. 

Character 
of  rash. 

Rash 
fades. 

Dura- 
tion of 
illness. 

Duration  of 
contagious- 
ness. 

Measles... 

10     to 

,14 
days. 

4th  day  of 
fever,     or 
after     7  2 
hours'  ill- 
ness. 

Small,     dull 
red  pimples, 
appearing 
behind    the 
ears  and  on 

On   ?th 
day      of 
fever. 

9   days. 

From     first 
day,    for 
exactly   3 
weeks. 

face. 

8    or    9 

Scarlet 
Fever. 

2  to  7 
days. 

2d  day  of 
fever,  o  r 
a  f  t  e  r  24 
hours'  ill- 

General  rosy 
blush  ap- 
pears fi  r  s  t 
about    neck 
and  shoul- 

On    sth 
day  af- 
t  e  r   fe- 
ver. 

days. 
(This 
does 
not  in- 
clude 

Six  weeks 
at  least. 

ders. 

se- 

quels.) 

Rose-color- 

ed,   slightly 

Typhoid 

10     to 
14 

7th     to 

elevated 
spots,      few 

14  to  21 

Not  conta- 
gious Tn- 

Fever. 

days. 

in    number, 

days. 

fectious. 

chiefly      on 

abdomen. 

Chicken- 
pox. 

12     to 

.   17 
days. 

2d  day  of 
fever,     or 
after  24 
hours'  ill- 
ness. 

Appears     in 
crops  on 
back  and 
abdomen, 
small,   red 
papules  rap- 
idly passing 
into    globu- 
lar vesicles. 

Thin 
scabs 
form 
about 
4th  day 
of  fever. 

7  to   12 
days. 

First  day, 
for  three 
weeks,  o  r 
a  full  week 
after  all 
dry  crusts 
have  d  i  s- 
appeared. 

Small,  hard, 

red  pimples, 

Scabs 

Small- 
pox. 

12 

days. 

3d  day  of 
fever,    or 
after  48 
hours'  ill- 

b  e  c  o  m  i  ng 
vesicles, 
then  pus- 
t  u  1  e  s,  ap- 
pearing first 

form  on 
9  t  h    or 

icthday 
of  fever, 
and    fall 

14  to  21 
days. 

First  day  , 
for  about 
6  weeks. 

on  face  and 

off  about 

neck. 

the  i4th. 

EMERGENCIES 


311 


OTHER  CONTAGIOUS  DISEASES. 


Date  of 

Disease. 

Period 
of  incu- 
bation. 

onset  of 
characteris- 
tic symp- 
toms from 

Characteristic 
symptoms. 

Duration  of 
illness. 

Duration  of 
contagious- 
ness. 

invasion. 

Redness,  glos- 

siness,    and 

i  puffiness        of 

affected    skin: 

5  to  7  days; 

Erysipelas.  .  . 

3    to    7 
days. 

ist    or    2d 
day 

area     circum- 
scribed,   p  i  t- 
ting  and  pain- 

several 
weeks      in 
cases   that 

From        ist 
day    for    2 
weeks. 

ful     to     pres-      extend. 

sure,  and  seat  ! 

of  burning  and 

smarting  pain. 

Fever. 

From     first 

;  Depends 

day    for    4 

False      mem-      upon   date 

to  6  weeks 

Diphtheria  .  . 

2  to  5 
days. 

ist  or  ad 
day. 

brane  on  ton-  i  of     begin- 
sils  and  other  j  ning    anti- 
parts  of  throat,    toxin      in- 

but     de- 
pends    up- 
on    results 

!  jections. 

o  f      throat 

cultures. 

From  onset 

o  f      initial 

Paroxysmal 

catarrhal 

cough   follow- 

symptoms 

- 

ed  by  a  crow- 

for 1  2  weeks 

j 

ing       inspira- 

or   until 

Whooping-         7  to  14 
cough.                days. 

2  to  4 
weeks. 

tion.      Parox- 
ysms    o  f  t  en 

12  weeks. 

whoop 
ceases. 

end    with    the 

Most  conta- 

expulsion   o  f 

gious     dur- 

glairy    mucus 

ing  whoop- 

or vomiting. 

ing     stage, 

4th  to  loth 

week. 

Swelling    in 

front,      below 

and     behind 

the  ear,  some- 

From   one 

Mumps  

1  7  to  20 
days. 

ist  day. 

times      below 
the  jaw;  pain 
on  movement 

7  to  14 
days. 

day    before 
symptoms 
appear 

of  jaw  or  neck, 

«.    ±/    ±j    ^    a.    i  , 

for  3  weeks. 

and    on   swal- 

lowing. 

312  HYGIENE    OF    THE   NURSERY 

It  may  be  well  to  give  a  few  directions  as  to  the 
management  of  a  fever  before  the  arrival  of  the 
physician.  Every  fever — whether  it  be  due  to  a 
poison  circulating  in  the  blood  or  to  a  passing  irri- 
tation of  little  or  no  moment — is  attended  by  the 
following  symptoms:  heat  of  skin,  lassitude,  loss  of 
appetite  and  thirst.  When  these  features  arise, 
the  mother  must  be  on  her  guard  and  take  steps 
to  place  her  charge  in  the  best  possible  condition. 
First  give  the  child  a  mustard  foot  bath;*  then  put 
him  to  bed  with  only  sufficient  covering  to  keep  up 
a  normal  body  temperature.  Reduce  the  diet  to 
the  simplest  possible  basis,  dilute  milk  food  being  the 
safest.  Plenty  of  pure  cool  water  taken  in  small 
quantities  at  short  intervals,  or  of  some  effervescing 
saline  water  may  be  allowed.  Febrifuges,  as 
aconite,  or  even  sweet  spirits  of  nitre,  had  best 
not  be  given  without  advice,  and  quinine  or  other 
remedies  are  not  to  be  trifled  with. 

Should  headache  be  severe,  place  cold  com- 
presses upon  the  forehead,  or  a  weak  mustard 
plaster  (one  part  of  mustard  to  six  of  wheat  flour)  on 
the  nape  of  the  neck. 

Free  urination  should  be  encouraged  by  hot 
compresses  over  the  bladder,  and  it  is  well  to  secure 
a  free  action  of  the  bowels  by  a  mild  saline  laxative. 

*  See  page  140. 


EMERGENCIES  313 

CONTAGIOUS  DISEASES  AND  DISINFECTION. 

There  are  certain  points  connected  with  the  nurs- 
ing of  contagious  diseases  and  the  subject  of  dis- 
infection that  are  worthy  of  mention. 

In  every  case  of  contagious  disease,  allow  in  the 
room  only  those  who  are  necessary  to  nurse  the 
sick.  The  nurse  must  avoid  overfatigue,  have 
regular  meals  of  digestible  and  nourishing  food, 
and  fixed  hours  for  sleep  and  relaxation.  The 
chamber  selected  for  the  sick-room  should  be  large, 
well  ventilated,  and  as  near  the  top  floor  of  the 
house  as  possible.  Upholstered  and  stuffed  furni- 
ture, curtains,  hangings,  carpet  and  other  articles 
capable  of  holding  disease  germs,  are  difficult  to 
disinfect,  and  should  be  removed  before  the  en- 
trance of  the  patient;  in  fact,  to  put  this  matter  in 
a  few  words,  the  sick-room  should  contain  only  such 
furniture  as  will  be  absolutely  needed  by  the  patient 
and  nurse.  Scrupulous  cleanliness  is  essential. 
Remove  dirty  dishes,  vessels  with  discharges,  soiled 
napkins,  and  the  like,  at  once. 

Disinfectants  are  substances  that  destroy  the 
infective  power  of  infectious  materials,  and  must 
not  be  confounded  either  with  antiseptics,  or  arrest- 
ors  of  putrefaction,  or  with  deodorizers,  or  neutral- 
izers  of  bad  smells. 

In  the  use  of  disinfectants,  it  is  important  to  bear 
in  mind  that  contagious  virus  must  be  destroyed  at 


314  HYGIENE   OF   THE   NURSERY 

its  source.  As  this,  of  course,  is  the  body  of  the 
sick,  all  discharges  must  have  their  power  for  evil 
destroyed  as  soon  as  possible.  Receive  discharges 
from  the  mouth  and  nose,  especially  in  cases  of 
scarlet  fever  and  diphtheria,  in  bits  of  rags,  and 
burn  them  immediately  after  use.  When  the  skin 
is  affected,  as  in  scarlet  fever,  for  example,  the 
flakes  that  fall  away  are  highly  infective.  To  pre- 
vent these  becoming  disseminated,  the  surface 
should  be  anointed  several  times  a  day  with  vase- 
line, lard  or  cocoa  butter,  all  of  which  substances 
will  be  rendered  more  efficient  by  the  addition  of 
carbolic  acid  (i  to  40).  After  recovery  from  scarlet 
fever  the  child,  before  breaking  quarantine,  should 
be  thoroughly  scrubbed  with  soap  and  water,  and 
then  sponged  with  a  solution  of  carbolic  acid  in 
water  (i  to  50)  or  of  bichloride  of  mercury  (i  to 
5000)  and  finally  washed  in  pure  water.  Two  such 
baths,  given  at  an  interval  of  about  twenty-four 
hours,  are  usually  quite  sufficient,  and  after  each 
bath  fresh  clothing  must  be  put  on.  The  patient's 
hair  must  be  cut  short  and  the  scalp  cleaned  and 
disinfected. 

Articles  used  about  the  patient,  such  as  sheets, 
pillow-cases,  blankets  and  clothes,  should  not  be 
removed  from  the  chamber  until  they  have  been 
soaked  for  at  least  an  hour  in  the  following  disin- 
fecting fluid : 


EMERGENCIES  315 

Sulphate  of  zinc 8  ounces. 

Carbolic  acid i  ounce. 

Water 3  gallons. 

After  this,  place  the  soiled  articles  in  boiling  water 
for  washing. 

Articles  not  requiring  to  be  frequently  changed, 
such  as  pillows  and  mattresses  need  disinfection. 
This  may  be  done  at  the  termination  of  the  sickness, 
and  is  best  accomplished  by  steam,  or,  if  this  be 
impossible,  they  must  be  burned. 

Keep  a  small  quantity  of  the  above  fluid  or  of  a 
solution  of  corrosive  sublimate  (i  to  1000)  in  all 
vessels  provided  for  receiving  the  discharges  of  the 
patient,  and,  after  these  are  used,  empty  quickly 
and  clean  with  boiling  water.  Water  closets  or 
privy  wells  into  which  these  discharges  are  poured 
must  also  be  disinfected  each  day  with  a  solution 
of  copperas  (one  pound  to  the  gallon).  In  case 
of  scarlet  fever  and  diphtheria  the  floor  of  the  sick- 
room should  be  washed  once  each  day  with  a  so- 
lution of  bichloride  of  mercury  (i  to  2000)  and  the 
walls  and  furniture  near  the  patient  wiped  frequently 
with  cloths  moistened  with  the  disinfectant.  In 
diphtheria  a  tray  of  carbolic  acid  solution  (i  to  40) 
should  be  at  hand  for  spoons,  syringes,  or  other 
instruments  employed  in  the  treatment;  and  spoons, 
cups  and  dishes  used  in  feeding  must  be  carefully 
sterilized  by  boiling  for  twenty  minutes. 


316  HYGIENE    OF   THE   NURSERY 

Fumigate  the  sick-room  as  soon  as  the  patient 
leaves  it.  To  do  this,  tightly  close  the  room  and 
stuff  all  apertures,  such  as  keyholes,  loose  window 
sashes,  spaces  under  doors  and  so  on,  with  cotton 
or  rags.  Then,  by  means  of  a  lamp  provided  for 
the  purpose,  or  by  a  Lister  fumigator,  the  air  is 
saturated  with  formaldehyde  gas  and  the  room 
kept  closed  for  at  least  twelve  hours  and  then 
thoroughly  aired. 

Wood-work  and  walls,  if  painted,  should  be 
wiped  down  with  a  solution  of  bichloride  of  mercury 
(i  to  2000)  and  then  scrubbed  with  soap  and  hot 
water,  and  the  floor  should  be  thoroughly  scrubbed 
with  the  same  solution.  Repapering  and  fresh 
painting  are  necessary  after  cases  of  scarlet  fever  or 
small-pox. 

The  person  of  the  nurse  may  be  disinfected  in 
the  way  already  indicated  for  the  patient. 

Both  milk  and  water  will  carry  disease  germs, 
and  hence  both  must  be  sterilized  when  there  is 
any  danger  of  their  being  contaminated.  Never 
give  delicacies  or  articles  of  food  that  have  stood 
in  the  sick  room  to  other  members  of  the  household. 

VACCINATION. 

Every  infant  should  be  vaccinated.  The  proper 
time  is  between  the  third  and  sixth  month,  though 
the  operation  may  be  postponed  if  there  be  any 


EMERGENCIES  317 

disease  of  the  skin,  and  in  very  delicate  subjects, 
if  there  be  no  risk  of  exposure  to  small-pox.  The 
point  selected  for  the  introduction  of  the  virus 
should  be  on  a  part  of  the  body  that  can  be  readily 
protected  and  kept  at  rest;  the  leg  in  infants, 
before  the  ages  of  creeping  and  walking,  the  arm 
in  later  life.  If  the  first  insertion  be  unsuccessful, 
it  must  be  repeated  after  a  month's  interval,  and 
continued  efforts  made  until  the  end  is  attained. 
A  second  vaccination  should  be  done  before 
puberty,  though  an  exposure,  or  any  risk  of  expo- 
sure, always  indicates  immediate  re-vaccination. 

VARIOUS  DRESSINGS. 
POULTICES. 

Poultices  may  be  made  with  corn-meal,  bread, 
starch,  ground  slippery  elm,  flax-seed  meal,  or,  in 
fact,  any  material  that  will  retain  heat  and  moisture. 
Flax-seed  meal  is  usually  selected  because  it  is 
bland  and  non-irritating;  because  it  contains  con- 
siderable oil,  which  gives  it  great  heat-retaining 
properties,  and  because  it  is  cheap. 

All  poultices  should  be  large,  from  half  an  inch 
to  an  inch  thick,  applied  as  hot  as  can  be  borne, 
and  renewed  as  soon  as  cold.  A  covering  of  oiled 
silk  or  thin  rubber  cloth  is  useful  to  prevent  rapid 
cooling  and  drying. 


318  HYGIENE    OF   THE   NURSERY 

FLAX-SEED  POULTICE. 

Take  a  perfectly  clean  bowl,  pour  in  the  requisite 
quantity  of  boiling  water,  then  add  the  flax-seed 
meal  slowly,  stirring  continually  with  a  large  spoon 
to  prevent  the  formation  of  lumps,  until  it  becomes 
stiff  enough  not  to  run  freely.  Spread  between 
two  layers  of  clean  muslin,  folding  the  edges  over  so 
as  to  avoid  soiling  the  part  to  which  it  is  applied. 

THE  JACKET  POULTICE. 

The  jacket  poultice,  sometimes  employed  in 
cases  of  pneumonia,  requires  some  skill  in  its 
preparation. 

For  a  child  from  one  to  three  years  old,  use  about 
a  pound  of  flax-seed  meal  in  each  poultice. 

Take  a  piece  of  muslin  or  a  large  towel  long 
enough  to  go  entirely  around  the  patient's  chest,  and 
of  sufficient  width,  when  folded  on  itself,  to  extend 
from  the  collar-bone  to  a  few  inches  below  the 
lower  end  of  the  breast-bone.  After  the  meal  is 
properly  mixed,  spread  it  evenly  over  one  entire  half, 
lengthwise,  of  the  cloth,  which  should  then  be 
folded  over.  Place  this  around  the  chest,  with  the 
open  edge  upward,  and  fasten  behind.  It  should  be 
held  up  by  a  tape  passing  over  each  shoulder. 

Put  this  poultice  on  as  hot  as  the  nurse  can 
tolerate  it  against  her  cheek;  cover  with  oiled  silk 
and  renew  every  three  or  four  hours.  When  the 


EMERGENCIES  319 

cool  poultice  is  to  be  removed  have  a  hot  fresh  one 
ready  for  immediate  application. 

COTTON  JACKET. 

This  dressing  has  almost  supplanted  the  jacket 
poultice  in  the  treatment  of  pneumonia  in  children, 
because  it  is  more  readily  applied,  is  much  lighter 
and  consequently  interferes  less  with  the  respiratory 
movements  of  the  chest  wall,  maintains  a  more 
uniform  temperature,  requires  changing  less  fre- 
quently, thereby  avoiding  fatigue  and  exposure, 
and  is  capable  of  gradual  removal  by  thinning  the 
cotton  from  time  to  time. 

A  muslin  waist  or  a  merino  undershirt  forms 
the  frame  of  the  cotton  jacket.  If  a  shirt  be  used 
it  must  have  the  sleeves  cut  off,  be  opened  all  the 
way  down  in  front,  and  so  arranged  that  when  put 
on  it  may  be  closed  by  tapes.  A  waist  should  reach 
well  up  in  front  and  behind,  and  down  to  the  base 
of  the  chest,  and  be  fastened  over  the  shoulders  and 
in  front  by  tapes.  To  the  inside  of  either  frame, 
a  thick  layer  of  cotton  must  be  basted,  and  to  the 
outside  a  complete  covering  of  oiled  silk.  Such  a 
jacket  need  not  be  changed  oftener  than  once  in 
twenty-four  hours,  and  may  be  worn  much  longer 
if  the  cotton  does  not  become  too  saturated  with  per- 
spiration or  rolled  into  hard  balls  by  the  restless 
movements  of  the  patient. 


320  HYGIENE    OF   THE   NURSERY 

PLASTERS. 
MUSTARD  PLASTER. 

These  plasters  are  used  for  the  purpose  of  making 
counterirritation,  and  must  be  graduated  in  strength 
according  to  the  tenderness  of  the  skin  and  the  end 
to  be  accomplished.  Pure  mustard  is  very  irri- 
tating and  will  quickly  blister  the  tender  skin  of  a 
child.  Flour  is  the  ordinary  diluent,  and  the 
strength  of  the  plaster  usually  ranges  from  one 
part  of  mustard  to  three,  six,  or  even  more  parts  of 
wheat  flour. 

In  making  the  plaster,  take  one  teaspoonful  of 
mustard  flour  and  add  to  it  three  teaspoonfuls  of 
wheat  flour;  mix  them  together  thoroughly  on  a 
plate,  and  put  on  as  much  hot  water  (never  vinegar) 
as  may  be  necessary  to  make  a  soft  mass.  Spread 
evenly  over  a  piece  of  muslin.  To  prevent  the 
mustard  from  adhering  to  the  skin,  place  a  piece  of 
gauze  or  thin  muslin  over  the  surface  of  the  plaster; 
turn  down  the  edges  as  in  poultices. 

Remove  the  plaster  after  the  surface  becomes 
quite  red,  usually  three  to  five  minutes. 

DRY,  HEATED  APPLICATIONS. 

Make  a  bag  of  thick  flannel,  somewhat  larger 
than  the  part  to  be  covered.  Half  fill  it  with  hot 
bran,  hops,  chamomile  flowers,  or  whatever  is  to  be 
used.  Apply  to  the  part  on  which  it  is  intended  to 


EMERGENCIES  321 

act.  Retain  it  there  by  a  bandage.  When  the  bag 
and  contents  become  cooled,  quickly  remove,  sub- 
stituting a  few  thicknesses  of  hot  flannel  until  the 
bag  can  again  be  heated  by  placing  it  on  a  tin  plate 
in  the  oven,  or  by  holding  it  over  burning  coals, 
being  careful,  of  course,  not  to  scorch  it. 

COLD-WATER  DRESSING. 

Take  a  piece  of  clean  old  linen  or  muslin  large 
enough  to  cover  the  affected  part.  Thoroughly 
wet  with  cold  water.  Keep  constantly  wet  by 
redipping  in  the  cold  water,  or  by  gently  squeezing 
out  a  wet  sponge  on  the  cloth,  so  as  to  keep  it  wet 
without  dripping.  The  latter  plan  is  the  better,  as 
it  causes  no  disturbance  of  the  parts  beneath — an 
important  consideration  in  many  cases. 

HOT-WATER  DRESSING. 

The  hot- water  dressing  is  prepared  in  the  same 
way  as  the  above,  substituting  hot  water  for  cold 
water,  and  covering  with  oiled  silk. 

TURPENTINE  STUPE. 

A  turpentine  stupe  is  made  by  wringing  a  piece 
of  soft  flannel  out  of  hot  water  and  sprinkling  a  few 
drops  of  warm  spirits  of  turpentine  on  it.  It  should 
be  covered  with  oiled  silk  while  applied,  and  re- 
moved when  sufficient  irritation  of  the  surface  is 
produced. 

21 


322  HYGIENE   OF   THE   NURSERY 

ADMINISTRATION  OF  MEDICINE. 

The  administration  of  medicine  often  requires 
considerable  skill,  and  is  a  task  in  which  more 
clumsiness  than  tact  is  often  exhibited.  Teach  the 
nurse  that  a  child  cannot  swallow  as  long  as  the 
spoon  is  between  the  teeth,  but  that  it  is  advisable 
to  depress  the  tongue  a  brief  moment  and  withdraw 
the  spoon  as  soon  as  emptied.  Should  the  child 
-rebel,  there  are  many  ways  by  which  he  can  be 
diverted,  so  that  he  shall  swallow  his  medicine  before 
he  knows  it.  Also,  should  he  have  a  fondness  for 
any  special  thing,  such  as  sugar,  jelly,  etc.,  the  taste 
of  the  medicine  may  be  quite  hidden  by  mixing  it 
with  the  thing  he  loves. 

Children  should  be  early  taught  to  show  tongue 
and  throat  and  to  gargle;  should  be  encouraged 
to  look  upon  a  Physician's  visit  as  a  pleasant  event, 
and  never  be  terrorized  into  compliance  by  threats 
of  what  the  Doctor  may  say  or  do. 


INDEX. 


Abdomen,  depression  of,  7 

distention  of,  7 
Adbominal  belt,  dispensing  with, 

80 

Abnormal  depression  of  tempera- 
ture, 41 
Accidents  at  birth,  279 

in  chidhood,  286 

Adenoid  growths,  symptoms  of,  19 
Air,  importance  of  fresh,  63 
Airing,  100 

in-doors,  101 

out-doors,  1 01 
Albumin  water,  202,  253 
Ammonia,  68 
Amusements,  98 
Anaemia,  temperature  in,  41 
Analysis  of  cow's  milk,  171 

of  human  milk,  169 

of  peptonized  milk,  201 
Ankle,  pressure  about  the,  91 
Aphthae,  43 
Appetite,  23 

loss  of,  24 
Apple,  scraped,  225 
Applications,  dry  heated,  320 
Apron,  the  bath,  126 
Arrowroot  pudding,  248 
Artificial  feeding,  166 
'Asses'  milk,  170 

Atmospheric  air,  the  amount  re- 
quired for  each  child,  54 
Attenuants,  183 
Author's  sterilizer,  215 


Baby  band,  80 

carriage,  102 

jumper,  dangers  of,  104 

powder,  130 

Baby's  basket,  the  filling  of,  77 
Bacteria  in  milk,  214,  219 
Baked  flours,  188 


Bare  legs  and  knees,  condemned, 

Barley  jelly,  202,  256 
and  milk,  205 

water,  202,  253 
Bath  apron,  126 

best  hour  for,  126 

blanket,  140 

bran,  141 

chair,  126 

cold,  137 

cooled,  138 

daily  full,  121 

disinfectant,  141 

"dqn'ts,"  129 

drying  after,  128 

for  first  ten  days,  120 

hot,  139 

hot  air,  133 

in  hot  weather,  130 

mode  of  giving,  122,  127 

mustard,  140 

quantity   of    water   required 
for,  123 

salt  water,  140 

sea,  134 

soap,  125 

soda,  141 

table,  122 

temperature  of,  123,  137 

the  initial,  119 

thermometer,  124 

vapor,  141 

when  to  omit,  131 

water  for,  123 
Bathing,  123 

after  third  year,  131 

on  lap,  1 20 

suit,  135 

time  occupied  in,  13 1 

utensils,  122 
Bed  coverings,  115 

remaking,  116 

separate,  114 

wetting  the,  29 
Beef  broth,  244 

juice  (raw),  202,  244 


323 


324 


INDEX 


Beef,  raw,  245 

tea,  peptonized,  241 

wine  and  iron,  158 
Bicarbonate  of  sodium  in  modi- 
fication of  milk,  182 
Bichloride  solutions,  care  of,  289 
Bicycles,  dangers  of,  no 
Binder,  the,  80 

method  of  fastening,  80 

when  to  discard,  94 
Birth,    injuries    received    during, 

279 

Blanc  mange,  243 
Bleeding  from   the  navel   string, 
280 

from  the  nose,  295 
Body  clothing,  81 

temperature,  39 
Boots,  rubber,  96 
Bottle  habit,  206 

tip,  208 

use  of  for  drinking  water,  153 
Boy  or  girl,  clothing  of,  94 
Braces,  107 

Brain,  "water  on  the,"  6 
Bran  bath,  141 
Bread,  227  _ 
Breast  feeding,  147 

importance  of    regularity  in, 
149 

time  allowed  for  each  meal, 
149 

milk,  analysis  of,  169 

conservation  of ,  152,  162 
specific  gravity  of,  169 
Breasts,  swelling  of,  283 
Breathing,  accelerated,  32 

diminished  frequency  of,  32 
Brick-dust  deposit,  30 
Broth,  beef,  244 

chicken,  246 

mutton,  247 

veal,  247 

Broths,  meats,  etc.,  244 
Brows,  contraction  of,  3 
Bruises,  286 
Burns  and  scalds,  290 
Buttocks  and  thighs,  bathing  of, 
130 


C. 

Cans  for  milk,  212 

Cap,  93 

Capacity  of  stomach,  179 

Carriage,  proper  kind  of,  102 

Casein  in  cow's  milk,  172 

in  human  milk,  172 

relative  proportions  in  cows' 
and  human  milk,  173 


Castile  soap,  unscented,  125 
Cereal  gruels,  231 

dextrinized,  237 
Cereals,  177,  226 
Chamber,  training  infants  to  use, 

305 

Chapin's  formulas,  237 
Chapin's  top-milk  mixtures,  236 
Chart    for   recording  weight   and 

length,  10 
Chest,  girth  of,  13 
Cheyne-Stokes'  respiration,  33 
Chicken  broth,  246 
Child,  position  of,  while  being  fed, 

Childhood,  2 

and  youth,  bathing  in,  133 

diet  in,  224 
Chill,  a,  309 
Chorea,  diet  and  regimen  in,  265 

massage  in,  275 

Cinchona,  ferrated  elixir  of,  158 
Clear  brown  soup,  245 
Cleft  palate,  284 
Cleanliness  in  milking,  212 
Clinical  thermometer,  37 
Clothing,  75 

change  of,  96 

shortening  of,  84 

warmth  of,  75 

weight  of,  13 
Coagulation  of  cow's  milk,  1 74 

of  human  milk,  174 
Coated  tongue,  43 
Cold  bath,  137 

cream,  130 

pack,  138 
Colds,  296 

Cold-water  dressing,  321 
Colic,  273,  301 

massage  in,  273 
Colostrum,  147 
Compresses,  142 
Condensed  milk,  174,  195 

advantages    and   defects 

of,  175 

Consomm^,  246 
Constipation,  272,  302 

massage  in,  272 
Contagious  diseases,  313 

table  of,  311 

Contamination  of  milk,  214 
Contraction  of  brows,  3 
Convulsions,  3,  20,  308 
Cooled  bath,  138 
Copperas,  68 
Corsets,  107 
Cotton  jacket,  319 
Cough,  21 
Cows,  care  of,  211 
Cows'  milk,  analysis  of,  171 


INDEX 


325 


Cows'  milk,  care  of,  212 

modification  of,  180 
Cream  with  condensed  milk,  176 

in  modification  of  milk,  181 

gravity,  184 
Creeping,  103 
Crib,  114 
Croup,  297 
Cry  of  hunger,  colic,  etc.,  20,  151 

whispering,  21 
Crying,  20 

variations  in  disease,  20 
Cuts,  288 
Cracked-wheat  water,  253 


D. 

Debility,  massage  in,  274 
Deformed  head,  5 
Dentition,  44 

abnormal,  45 
delayed,  46 
irregular,  46 
premature,  46 
Desserts,  227 
Development,  7 

examples  of  variations  in  dis- 
ease, 17 
Diagram  showing  relative  stature, 

14 
showing     eruption     of     milk 

teeth,  44 

showing  relation  between  per- 
manent     and      temporary 
teeth,  48 
Diaper,  79 

washing  and  drying,  79,  80 
when  to  discard,  94 
Diarrhoea,  27 

Diet  and  regimen  in  chorea,  265 
during  the  eighth  and  ninth 

months,  186 
the  first  week,  184 
the    sixth    and    seventh 

months,  186 
for     acute     gastro-intestinal 

disorders,  258 
chronic  diarrhoea,  six  to 

twelve  months,  260 
chronic        gastro-intesti- 
nal catarrh,  259 
chronic    vomiting  of  in- 
fants  259 
feeble  digestion,  age  four 

months,  257 
habitual        constipation, 

infants,  261 
older  children,  262 
mucous  disease,  259 


Diet  from  the  second  to  the  sixth 

week,  185 
the  sixth  week  to  the  end 


of  two  months,  185 

S13 

month,  185 


the    third    to    the    sixth 


the    tenth   to    the   four- 
teenth month,  1 88 
the    fourteenth    to    the 
eighteenth  month,  189 
eighteen  months  to  two 

and  a  half  years,  190 
two  and  a  half  to  three 

and  a  half  years,  191 
in  acute  nephritis,  263 
gouty  eczema,  264 
illness,  229 
infantile  scurvy,  262 
lithaemia,  264 
pulmonary  phthisis,  265 
rickets,  264 
Dietary,  230 

in  childhood,  224 
in  special  diseases,  257 
"no  milk,"  for  acute  gastro- 
intestinal disorders,  258 
Diseases,  contagious,  313 
Disinfectants,  definition  of,  313 
Disinfection,  etc.,  313 
Donkey,  a,  106 
Drawers,  separable,  85 
Dress,  or  slip,  81 

night,  92 

Dressing  gown,  92 
Drink,  228 
Drinking,  22,  192 

water,  192 

Drowsiness,  long-continued,  19 
Dry  malt  extracts,  184 
Drying  after  bath,  128 


E. 

Earache,  19,  296 

Ear,  foreign  bodies  in,  292 

Early  rising,  113 

Ear-tabs,  96 

Ears,  water  in,  128 

Eating  between  meals,  229 

Effleurage,  268 

Egg  and  brandy, 25 2 

Eggs,  226 

Emergencies,  278 

Enemata,  nutritious,  256 

Erect  carriage,  securing  of,   107 

Eructation  of  milk,  25 

Eruptive  fevers,  table  of,  310 

Electricity  with  massage,  275 

Electric  light  in  nursery,  56 

Evacuations,  fecal,  26 


326 


INDEX 


Evacuations,  normal  number  of,  26 
Excoriations,  80 
Exercise,  effects  of,  98 

the  infant's  first,  99 

out-door,  10 1 
Expectoration,  absence  of  in  young 

children,  22 
Extract  of  malt,  158 
Eyeballs,  oscillation  of,  3 
Eyes,  change  of  color  of  the,  17 

foreign  bodies  in  the,  292 

inflammation  of  the,  283 

lividity  of  the  lids,  5 

washing  of,  120 
Eyelids,  incomplete  closure  of,  2 

twitching  of,  2 


F. 


Face,  the,  2 

congested  or  blackened,  280 

examples  of  variations  in  dis- 
ease, 2 

Faecal  evacuations,  general  charac- 
ter of,  26 

Fasces,  retention  of,  282 
Fall  and  winter,  diseases  of,  278 
False  palate,  285 
Fat  in  cow's  milk,  181 

in  human  milk,  169 
Farinaceous  food,  177 
Feather  bed,  objections  to,  115 
Features  of  health,  i 
Feeding,  artificial,  166 

by  a  wet-nurse,  164 

from  the  maternal  breast,  146 

mixed,  152,  162 

table  of  intervals  of,  187 

too  constant,  150 

time  of  difficult,  194 

with  cup,  206 
Fender,  63 
Fever,  35,  43,  3°9 
Fevers,  table  of  eruptive,  310 
Feet,  cold,  91 

shape  of,  89 

Finger  nails,  care  of,  143 
Fireplace,  open,  62 
Fish,  226 

Fissure  of  nipples,  158 
Flax-seed  tea,  252 

poultice,  318 
Flies     and     mosquitoes,     dangers 

from,  59 
Flour  ball,  255 
Fontanelle,  conditions  of,  5,  6,  7 

when  it  should  close,  17 
Food,  146 

articles    to    select    from    in 
childhood,  225 


Food,  administration  of  artificial, 

206 

average  amounts  of,  178 
farinaceous,  177 
fried,  229 
indications  for  minor  changes 

in,  203 
Meigs',  195 
milk  and  oatmeal,  230 
milk  and  white  of  egg,  238 
quantity  per  diem,  178 
Foods,  peptomzed,  197 
Foot-bath,  mustard,  140 
Foreign  bodies  in  the  alimentary 

canal,  295 

laxative,  contraindicated    in, 
295 

in  the  ear,  292 
in  the  eye,  292 
in  the  nose,  294 
in  the  throat,  294 
Fractures,  287 
Friction,  268,  271 
Fruits,  227 
Fumigation,  316 


G. 

Garments,  method  of  fastening,  83 

Garter,  86 

Gastric  juice,  effect  of,  on   milk, 

174. 
Gelatine,  255 

and  milk,  250 
Genitals,  care  of,  128 
Glutin  suppositories,  307 
Gluttony,  24 

Glycerin,  suppositories,  308 
Goats'  milk,  170 
Gown,  dressing,  92 
Graduated  nursing  bottle,  207 
Gravity  cream,  184 
Growth,  7,  12,  14 
Gruel,  oatmeal,  251 

cereal,  237 

dextrinized,  237 


Habitual  constipation,  302 

diet  for,26i,  262 
Hair,  care  of,  144 

change  of  color  in,  17 
drying  of,  132 
falling  out  of,  144 
tonic,  145 

Hand,    carrying    of,    to    head    or 
mouth,  19 


INDEX 


327 


Hard  palate,  43 

Harelip  and  cleft  palate,  284 

age  for  operating  on,  284 
Hat,  light  straw,  93 
Head,  shape  of,  5 

after  prolonged  labor,  279 

squareness  of,  6 

washing  of ,  121,  129,  132 

when  it  can  be  held  erect,  16 
Health,  the  features  of,  i 
Healthy  skin,  characters  of,  3 
Hereditary  tendency,  279 
Hoarseness,  21 
Hominy  grits,  249 
Horlick's  Food,  183 
Hot  bath,  139 
Hot-water  dressing,  321 
Human  milk,  analysis  of,  169 

substitutes  for,  170 
Humanized  milk,  201,  242 
Hunger,  23 
Hydrocephalus,  6 


Ice  water,  109,  192 
Indigestion,  massage  in,  271 
Indications  for  minor  changes  in 

food,  203 

Infancy,  definition  of,  i 
Infant,  clothing  required  by,  78 
holding  in  place,  83 

development  of  the,  7 

drying  of  the,  127 

fed  upon  condensed  milk,  174 

foods,  177 

initial  bath  of,  119 

overfed,  179 

position  of,  while  feeding,  2.10 
while  nursing,  148 

rocking  of,  116 

the  hardening  of  an,  101 

the  jolting  of  an,  100 

when  able  to  sit  up,  99 
creep,  etc.,  103 

Inflammation  of  the  eyes,  283 
Injuries  received  during  birth,  279 
Insects,  stings  of,  291 
Intervals  of  feeding,  table  of,  180 


J. 

Jacket,  cotton,  319 
P9ultice,  318 

Jaundice,  5,  30 

Jelly,  sago,  251 

Junket,  249 

with  egg,  249 


Lactation,  148 

diet  dunng,  157 
normal  dura^n  of,  153 

Lactalbumin,  relative  proportions 
in  cow's  and  human  milk,  173 

Lactometer,  171 

Leggings,  93,  96 

Legs,  bare,  76 

Length-chart,  10 

Liebig  foods,  186 

Light,  night,  56 

Lime,  saccharated  solution  of,  183 
water,  182,  254 

Lime    water    in    modification    of 
milk,  182 

Lips,  lividity  of,  5 


Malt  extract,  158 
Mammary  abscess,  160 
Mammary    glands,    inflammation 

of,  283 
Manna,  307 
Manners,  107 
Massage,  267 

a  frictions,  268 

dry,  269 

Maternal  feeding,  146 
Mattress,  114 

Meals,  arrangement  of,  in  child- 
hood, 228 

preparation  of,  209 

of  day's  supply,  209 
of  separate  bottles,  210 

regularity  of,  149 
Meat,  226 

broths,  244 
Medicine,  administration  of,  322 

closet,  contents  of,  60,  6 1 
Meigs'  Food,  195 
Mellin's  Food,  183,  205 

laxative  action  or,  188 
Menstruation,  effect  of  recurrence 

on  breast  milk,  160 
Milk,  225 

bacteria  in,  214,  219 

contamination  of,  214 

and  barley  jelly,  205 

and  gelatine,  250 

and  oatmeal,  230 

and  white  of  egg  food,  238 

asses',  170 

boiled,  195 

breast,  168 

examination  of,  169 
regulation  of  the  flow  of, 
148 


328 


INDEX 


Milk,   breast,  scanty  secretion  of, 

158 

specific  gravity  of,  169 
substitutes  for,  170 
to  ascertain  the  quantity 

sucked,  161 
condensed,  174 
cows',  171 

care  of,  212 
goats',  170 

gruel,  peptonized,  240 
human,  169 
humanized,  201,  242 
keeping  of ,  212,  213 
mixed,  211 
modification  of,  180 
partially  peptonized,  199,  239 
pasteurization,  218 
danger  of,  213 
when  to  employ,  224 
pasteurized,  cooling  and  care 

of,  223 

keeping  of,  224 
peptonized,  197 

analysis  of,  201 
powder,  peptogenic,  199 
predigested,  197 
secretion  established,  147 
sound, 211 
sterilized,  214 
sugar,  181 
teeth,  44 

care  of,  143 
transportation  of,  212 
Mind,  cultivation  of,  107 
Modification  of  cows'  milk,  180 
Morals,  general,  108 
Mouth,  examination  of,  41 
inflammation  of,  22 
mucous  membrane  of,  43 
washing  of,  121,  128 
Mustard  bath,  140 

plaster,  320 
Mutton  broth,  247 

N. 

Nap,  the  morning,  112 

Napkins,  79 

Navel  string,  bleeding  from,  280, 

281 

Neurasthenia,  massage  in,  276 
New-born  infant,   length,  weight, 

etc.,  7 
Night  dress,  92,  95 

light,  56 
Nipple,  fissures  of,  158 

preparation  of  the,  159 

protector,  159 

"No  milk"  diet,  258 
Nose,  3 


Nose,  bleeding  from  the,  295 

cleaning  of,  128 

foreign  bodies  in  the,  294 

rubbing  of  the,  20 
Nostrils,  sharpness  of,  3 
Nursery,  51 

airing  of,  67 

cleaning  the,  67 

floor  of  the,  57 

furnishing  of  the,  57 

heating  of  the,  61 

height  of  ceiling  of  the,  55 

lighting  of  the,  55 

night,  52 

situation  of  the,  52 

size  of  the,  54 

smoking  forbidden  in,  67 

sun-light  in,  52 

temperature  of  the,  61 

ventilation  of  the,  63,  67 

walls  and  ceiling,  58,  59 
Nurse-maid,  69 

cleanliness  of,  73 

duty  of  mother  to,  73 

face  of,  71 

selection  of,  age,  etc.,  70 
Nursing  bottle,  care  of,  208 
graduated,  207 
tip,  209 

for  cleft  palate,  285 
Nutritious  enemata,  256 

0. 

Oatmeal  gruel,  251 

water,  253 

Opium  preparations,  dangers  of,  61 
Oral  mucous  membrane,  42 

respiration,  33 
Orange  juice,  192 

quantity  to  be  given,  193 
Overcoat,  93 
Overfeeding,  179 
Oyster  soup,  247 
Oysters,  peptonized,  241 
Oxide  of  zinc  ointment,  130 


P. 


Palate,  false,  285 

hard  and  soft,  43 
Pancreatin,  197 
Paralysis,  facial,  massage  for,  276 

infantile,  massage  for,  274 
Pasteurization,  219 

advantages  of,  224 

effect  of,  on  microorganisms, 
219 

with    improvised    apparatus, 
223 


INDEX 


329 


Pasteurizer,  Dr.  Freeman's,  220 
Passages,  character  of,  27 
Pathogenic  organisms  in  milk,  2 14 
Pearl  barley  jelly,  256 
Peptogenic  milk  powder,  199 
Peptonization,  197 

by  cold  process,  240 

partial,  199,  257 
Peptonized  beef  tea,  24 1 

foods,  238 

milk,  238,  239 
gruel,  240 

oysters,  241 
Pe"trissage,  268 
Phosphate  of  sodium,  307 
Physiological   action   of  massage, 

269 

Pictures  in  nursery,  58 
Pillow,  the,  115 
Plasters,  mustard,  320 
Platt's  chlorides,  68 
Play,  109 

during  convalescence,  no 
Pleuritic    effusions,    massage    for, 

276 

Position  and  gestures,  18 
Position  in  bottle  feeding,  210 
Pony,  the,  106 
Poultices,  317 

jacket,  318 
Powder,  baby,  130 
Predigested  milk,  197 
Pregnancy,    effect    of    on    breast- 
milk,  1 60 

Prepared  chalk,  142 
Preparation  of  food,  184 
Protector,  nipple,  159 
Proteids  in  cows'  milk,  172 

in  human  milk,  169 
Puberty,  bathing  after,  133 
Pudding,  arrowroot,  248 

rice,  250 

tapioca,  252 
Pulse,  the,  33 

in  fever,  35 
Pyramid  night  light,  56 


Rain  water,  123 
Raw  beef,  245 

juice,  202,  244 
Reaction  of  cows'  milk,  171 

of  human  milk,  169 
Rectal  temperature,  38 
Regular  nursing,  influence  in  milk, 

149 

Regurgitation  of  milk,  25 
Rennet,  249 
Respiration,  31 


Retention  of  faeces  and  of  urine, 

282 

Retiring  at  night,  114 
Rice  milk,  250 

pudding,  250 

water,  253 
Rickets,  6,  19,  175 
Riding,  106 
Rising  early,  113 
Robinson's  barley,  188 
Rocking  baby  to  sleep,  116 
Roller  skates,  no 
Roof  of  the  mouth,  43 
Rubber  cloth,  84,  92 
Rubbing,  270 


Sago  jelly,  251 

Saliva,  secretion  of,  17 

Salt-water  bath,  140 

Scalds,  290 

Scalp,  swelling  of,  280 

Screens  for  nursery  windows,  59 

Scurvy  from  condensed  milk,  175 

from  farinaceous  foods,  177 
Sea-bathing,  135 

faintness  after,  135 

season  for,  134 
Sea-water  baths,  134 
Secondary     bleeding     from     the 

navel,  281 

Second  dentition,  features  of,  49 
Set  walks,  105 
Shirt,  night,  92 
Shoes,  87 

fastenings,  91 

soles,  91 
Shoes,  bedroom,  93 

knitted,  worsted,  79 
Short  stockings,  dangers  of,  75 
Sick  room^  disinfection  of,  313 
Sitting  erect,  16 
Skates,  roller,  dangers  of,  no 
Skin,  general  appearance  of,  3 

of  healthy  child,  3 

yellow  staining  of,  282 
Sleep,  in 

amount  required,  in 

training  for,  111 

variations  in  disease,  19 
Sleeping  "  cool,"  19 

"  high,"  19 

hours,  rules  for,  112 

out-of-doors,  116 
Soap,  Castile,  125 

care  in  use  of,  125 

suppositories,  307 
Soda  bath,  141 
Solution  of  lime,  saccha rated,  183 


330 


INDEX 


Sore  nipples,  158 

prevention  of,  159 
Sound  milk,  211 
Soup,  clear  brown,  245 

oyster,  247 
Soups,  227 

Spasmodic  croup,  297 
Spine,  curvature  of,  99 
Spinal   irritability,    massage    for, 

276 
Sponge,  125 

care  of,  125 
Sponging,  120 

time  occupied  in,  132 

to  reduce  temperature,  139 
Sprains,  287 
Spring   and  summer,  diseases  of, 

279 

Squinting,  3 
Standing,  17 
Starch  gruel,  237 
Stationary  wash  stands,  cleaning 

of,  68 

Sterilization,  214 
Sterilized  milk,  properties  of,  217 
Sterilizer,  215 

Stick  for  cleaning  teeth,  143 
Stimulants  for  scanty  milk  secre- 
tion, 158 

Stings  of  insects,  291 
Stockings,  85 
Stomach,  capacity  of,  179 
Study,  too  much,  109 
St.  Vitus's  dance,  massage  in,  275 
Substitutes  for  human  milk,  170 
Suck,  manner  of  giving,  148 
Sugar  in  cows'  milk,  171 

in  human  milk,  169 

in  modification  cf  milk,  181 

of  milk,  181 

solutipn,  181 
Summer  night-gown,  92 
Suppositories,  glutin,  307 

glycerin,  308 

soap, 307 
b  wallowing,  22 
Swelling  of  the  breasts,  283 
Swimming,  136 
Syphilis  in  nurse-maid,  70 
Syringe  for  constipation,  303 

nutritive  enemata,  256 

T. 

Table  of  average  amounts  of  food, 

180 

of  feeding,  187 
Table,  the  bath,  122 
Table  of  the  eruptive  fevers,  310 
of  other  contagious  diseases, 
3" 


Table  showing  increase  in  length, 

8 

in  weight,  9 
Taking  cold  easily,  106 
Talking,  17 
Tapioca,  251 

pudding,  252 
Tapotement,  209 
Tears,  secretion  of,  17 

suppression  of,  21 
Teeth,  care  of,  142 

permanent,  order  of  eruption, 
47 

premature  appearance  of,  45 

children  born  with,  45 

milk,  43 

stick  for  cleaning,  143 
Teething,  increase  of  saliva  in,  45 

pauses  in,  44 
Temperature  of  bath,.  123,  137 

nurseries,  62 

manner  of  taking,  37 

normal,  39 

range  of  in  health,  40 

in  disease,  40 
Thermometer,  bath,  124 

clinical,  37 

food,  210,  242 
Throat,  examination  of,  41 

foreign  bodies  in  the,  294 
Toes,  normal  position  of,  89 
Toe  nails,  care  of,  94,  143 
Tongue,  the,  42 

coated,  43 
Tongue-tie,  286 
Tonsils,  19,  43 
Tooth-brush,  143 
"Top  milk,"  231 

mixtures,  232 

change  to  whole  milk,  233 
Towels,  bath,  125 
Toys,  60 
Treatment  of  fissure  of  the  nipple, 

158 

Tuberculin  test  for  cows,  211 
Turpentine  stupe,  321 
Twitching  of  eyelids,  3 


U. 


Ulceration  of  the  navel,  281 
Underclothing,  cotton  stockinet,  95 

linen-mesh,  95 

woolen,  94 

Urination,  painful,  30 
Urine,  the,  28 

amount  voided  in  24  hours,  29 

high  colored,  30 

incontinence  of,  29 

in  jaundice,  30 


INDEX 


331 


Urine,  retention  of,  282 

smoky,  30 

suppression  of,  29 
Uvula,  the,  43 
Uric  acid,  excess  of,  30 

V. 

Vaccination,  316 
Veal  broth,  202,  247 
Vegetables,  226 
Ventilation,  54,  63 
Ventilator  board,  66 

wheel,  66 

window,  64 
Vernix  caseosa,  119 
Veterinary  inspection  of  cows,  211 
Voice,  20 

variations  in  disease,  20 
Vomiting,  25,  300 

W. 

Walking,  delay  in,  18 
Walks,  104 
Wash  cloth,  125 

care  of,  125 

Waste  pipe,  disinfection  of,  68 
Water,  for  drinking,  192 

in  the  ears,  128 

on  the  brain,  6 
Weaning,  153 

gradual,  154 

indications    for,   on   part   of 

infant,  162 
mother,  156 


Weaning  in  difficult  cases,  155 

in  summer,  153 

manner  of,  154 

premature,  156 

sudden,  155 
Weather,  cold,  96 

damp  and  rainy,  96 
Weight-chart,  10,  n 

recording  of,  12 

table  showing  increase  of,  9 

monthly  gain  of,  9 
Wet-nurse,  164 

selection  of,  164 
Wetting  the  bed,  29 
Whey,  195,  254 

mixtures,  196 

wine,  252 
Window  screen,  59 

ventilator,  64 
Winter  night-gown,  92 

to  summer  clothing,  rules  for 

changing,  96 
Winters'  formulas,  233 

general  formulas,  234 

summer  formulas,  235 


Y. 

Yawning,  33 

Yellow  staining  of  the  skin,  282 


Z. 

Zinc  ointment,  130 


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